Blog Entry List
Effective Jan. 15, 2018, updates to Clinical Coverage Policy 3D, Hospice Services, are approved. The amended policy is posted to the North Carolina Medicaid website.
Revisions to the policy include the implementation of:
This article covers: Clinical Coverage Policy 12B and State Plan Amendment, 2018 Recertification Process, Stakeholder Engagement and, History and Purpose of HIV Case Management Services.
The following new or amended combined North Carolina Medicaid and NC Health Choice clinical coverage policies are available on North Carolina Medicaid’s Clinical Coverage Policy web pages.
If a provider’s enrollment application or Manage Change Request (MCR) is clean and does not contain errors, it will process more quickly. The NCTracks Enrollment Team identified commons errors that cause delays in processing applications and MCRs.
Providers have until April 30, 2018, to submit a complete and accurate attestation for Program Year 2017.
Effective May 1, 2017, new pharmacy point of sale clinical edits for behavioral health medications were applied for pediatric and adult beneficiaries.
Registration is open for the February 2018 instructor-led provider training courses listed below. Slots are limited.
Facility providers can now access Sterilization Consent Form status, including denial reasons, on the secure NCTracks Provider Portal.
Effective April 1, 2018, when performing a wet mount screening, providers serving Family Planning Medicaid (MAFDN) beneficiaries shall bill procedure code 87210 (smear, primary source with interpretation; wet mount for infectious agents [e.g., saline, India ink, KOH preps]). If both saline and potassium hydroxide (KOH) methods are needed, two units may be billed. Wet mount screenings may be performed during the annual exam or during any of the six inter-periodic visits allowed per 365 days under Family Planning Medicaid, when a sexually transmitted screening is required.
At various times of the year, Medicaid providers may receive notification of participation letters from the DMA Office of Compliance and Program Integrity which facilitates audits from various auditing agencies, e.g. Office of the Inspector General, Office of Internal Auditor, and Office of State Auditor.
Clinical Coverage Policy 5A-2, Respiratory Equipment and Supplies, is updated to add policy guidelines for home ventilators with a non-invasive interface and to add HCPCS codes E0466 to the Durable Medical Equipment and Supplies fee schedule as a continuous rental.
North Carolina Medicaid received calls concerning claim denials for some services provided by nurse practitioners (NPs) and physician assistants (PAs).
Medicaid has provided instructions to NCTracks to update the claims processing system. The following procedure code list is updated to include additional NP and PA taxonomies. Newly added codes are:
Effective with the date of service of April 31, 2018, the North Carolina Medicaid and N.C. Health Choice programs will be terminating Clinical Policy 1B-1, Botulinum Toxin Treatment, within the Physician Drug Program.
Effective with the date of service of April 31, 2018, the North Carolina Medicaid and N.C. Health Choice programs will be terminating Clinical Policy 1B-1, Botulinum Toxin Treatment, within the Physician Drug Program.
Botulinum Toxin Type A (Botox) HCPCS code J0585 Botulinum Toxin Type A, per unit: Billing Guidelines
Effective with the date of service April 30, 2018, the North Carolina Medicaid and N.C. Health Choice programs will be terminating Clinical Policy 1B-1, Botulinum Toxin Treatment, within the Physician Drug Program.