Blog Entry List
As of Dec. 1, 2018, there are no NC Medicaid policies posted for public comment.
Proposed new or amended Medicaid and NC Health Choice clinical coverage policies are posted for comment throughout the month. Visit Proposed Medicaid and NC Health Choice Policies for current posted policies and instructions to submit a comment.
NC Medicaid Clinical Policy, (919) 855-4260
The following new or amended Medicaid and NC Health Choice clinical coverage policies were posted since Nov. 1, 2018.
System changes have been completed to allow non-psychiatric Nurse Practitioners and Physician Assistants to receive reimbursement for CPT codes 90791 – Psychiatric Diagnostic Evaluation and 90792 – Psychiatric Diagnostic Evaluation with Medical Servicess when provided via telemedicine/telepsychiatry.
Medicaid has designated specific ICD-10-CM diagnosis codes that do not count toward the annual visit limitation. These codes are reviewed regularly and updated as appropriate. The following ICD-10-CM codes will be added to this list of diagnosis codes for claims with dates of service on or after Jan. 1, 2019:
• F11.20 (OPIOID DEPENDENCE, UNCOMPLICATED)
• Z79.891 (LONG TERM [CURRENT] USE OF OPIATE ANALGESIC)
Visit NC Medicaid Annual Visit for more information.
This edit is in place to ensure billing providers are affiliated with the rendering (individual) providers for whom they are billing to prevent inaccurate payment or fraud.
Enrollment applications submitted with incorrect data including name, social security number and date of birth result in application denials and withdrawals. As a result, providers must submit new applications and pay any applicable fees.
The Money Follows the Person Demonstration Project (MFP) team is preparing for the 2019-2023 Medicaid Transition Period and has updated its application for the coming year. MFP will continue to transition individuals on Medicaid from skilled level, long-term care facilities back to the community until all populations are folded into Medicaid Managed Care. The new application will be effective for participation requests starting Jan. 1, 2019, and will be available on the MFP website after Dec. 1, 2018.
In response to the anticipated higher than normal number of influenza cases this coming season, effective December 1, 2018, North Carolina Medicaid is offering telephonic evaluation and management services to beneficiaries who are actively experiencing flu-like symptoms. The purpose of this service is to assist primary care providers assessing established patients over the telephone to gather additional information.
NC Medicaid has instructed Health Management System (HMS) to resume audits of hospital outpatient claims. These reviews are commencing now, as the claims adjustment reason code issue has been resolved. NC Medicaid appreciates the assistance of the provider workgroups to identify issues and confirm improvements once system enhancements were completed. HMS will also continue its other assigned third-party liability reviews.
Effective with date of service Oct. 3, 2018, North Carolina Medicaid and NC Health Choice programs cover mogamulizumab-kpkc injection, for intravenous use (Poteligeo), for use in the Physician Administered Drug Program when billed with HCPCS code J9999 - Not Otherwise Classified, Antineoplastic Drugs.
Effective with date of service Oct. 8, 2018, North Carolina Medicaid and NC Health Choice programs cover cemiplimab-rwlc injection, for intravenous use (Libtayo) for use in the Physician Administered Drug Program when billed with HCPCS code J9999 - Not Otherwise Classified, Antineoplastic Drugs.
Out-of-state providers, including border-area providers, must be enrolled in Medicare or their home-state Medicaid program to enroll in North Carolina Medicaid and NC Health Choice programs. If Medicare participation cannot be verified, NCTracks will contact the home-state Medicaid program for verification.
Required Medicare participation based on taxonomy will be verified, and home-state Medicaid participation will not be required.
In accordance with the North Carolina Medicaid State Plan, Federally Qualified Health Centers and Rural Health Centers may request a rate adjustment due to change in scope of services.
This article talks about the new help desk number for PASRR, the new fax number for PASRR-related documents and uploading PASRR-related documents to NCMUST.
Proposed Clinical Coverage Policies for Public Comment
Proposed new or amended Medicaid and NC Health Choice clinical coverage policies are posted for comment throughout the month. Visit the Proposed Medicaid and NC Health Choice Policies for current posted policies and instructions to submit a comment.
As of Nov. 1, 2018, the following NC Medicaid policies are open for public comment: