The following new or amended combined North Carolina Medicaid and NC Health Choice clinical coverage policies are available on Medicaid’s Clinical Coverage Policy web pages.
Blog Entry List
42 CFR 455.450 requires a state Medicaid agency to screen all initial provider applications based on a categorical risk level of “limited,” “moderate,” or “high.”
The NC Division of Medical Assistance (DMA) currently recognizes CPT Code 27216 (Percutaneous skeletal fixation of posterior pelvic bone fracture and/or dislocation, for fracture patterns that disrupt the pelvic ring, unilateral).
In response to provider comments and questions regarding the December 2017 Special Bulletin, Billing Guidance:340B Modifiers, North Carolina Medicaid is publishing updated information regarding the use of the JG, TB and UD modifiers which are required to identify 340B drug claims.
The Secretary of the N.C. Department of Health and Human Services (DHHS) has approved the disengagement of Columbus County from the Eastpointe Local Management Entity – Managed Care Organization (LME-MCO) and their realignment with Trillium Health Resources LME-MCO.
Registration is open for several instructor-led training courses for providers that will be held in May 2018. Slots are limited.
Effective May 1, 2018, North Carolina Medicaid will cover digital breast tomosynthesis (3D tomosynthesis) for both screening and diagnostic mammography.
Effective May 1, 2017, new pharmacy point of sale clinical edits for behavioral health medications were applied for pediatric and adult beneficiaries. Note: This article was originally published in February 2017 Medicaid Bulletin.
Effective May 1, 2018, Clinical Coverage Policy 1C-1, Podiatry Services, is revised to include annual updates to International Classification of Diseases (ICD-10-CM) codes.
The implementation of ICD-10-CM allows specificity for accurate coding, resulting in greater justification of medical necessity. A provider’s documentation must include details to completely depict the nature of a beneficiary’s diagnosis and procedures performed.
Note: This article was previously published in the September 2017 Medicaid Bulletin. It is republished with updates regarding edit disposition.
Effective Oct. 29, 2017, the NC Department of Health and Human Services (DHHS) validates through NCTracks that the billing provider’s address submitted on the claim corresponds to the location listed on the provider record for the dates of service submitted. The billing provider address, city, state and zip code (first five digits) on all North Carolina Medicaid and NC Health Choice claims must match exactly with the corresponding information on the provider record. (The match is not case sensitive.)
Per Session Law (S.L.) 2015-241, as of June 1, 2018, hospitals, mid-level physicians and nurse practitioners who currently have an electronic health record system must be connected to NC HealthConnex to continue to receive payments for Medicaid and NCHC services.
By July 1, 2018, Medicaid behavioral health providers added to NCTracks by their current Local Management Entity/Managed Care Organization Provider Upload Process must complete re-verification.
The Department of Health and Human Services, Division of Medical Assistance, provides notice of its intent to amend the Medicaid State Plan to increase the rates for metabolic formula – Durable Medical Equipment.
Topics include: list of providers due for re-credentialing, changes to re-credentialing process and changes to ongoing verification process.