Effective July 1, 2021, some Medicaid beneficiaries receiving Personal Care Services (PCS) transitioned from NC Medicaid Direct to receiving services through an NC Medicaid Managed Care health plan.
Blog Entry List
Health plans have identified a common billing error of providers submitting professional and institutional EDI claims.
Effective July 29, 2021, Session Law 2021-62 (NC Senate Bill 594), repeals portions of the 2020 COVID-19 Recovery Act that permitted the temporary lifting of certain enrollment requirements for providers enrolling in NC Medicaid during the global healthcare emergency.
Effective with date of service May 11, 2021, Medicaid and NC Health Choice cover loncastuximab tesirine-lpyl for injection, for intravenous use (Zynlonta).
Effective with date of service May 17, 2021, Medicaid and NC Health Choice cover dostarlimab-gxly injection.
This Bulletin includes key milestone dates for NC Medicaid Managed Care, Provider Playbook updates, prior authorization updates, contracting reminders, information about health plan events, the provider ombudsman and upcoming AHEC events and webinars. It also includes information about the Provider and Health Plan Lookup Tool, PHP Quick Reference Guide and the NC Medicaid Help Center.
ADDENDUM to Special Bulletin #168: The addendum was updated to include information regarding guidance on billing and coding criteria, guidance for parents, counseling methods, reimbursement ranges and the time frame during which the code is valid.
This is a reminder to include taxonomy codes when submitting claims to PHPs, either by individual providers or through a trading partner.
This Special Bulletin is being released to inform NC Medicaid providers of COVID-19 rate reimbursement that providers will receive from Prepaid Health Plans (PHPs) under NC Medicaid Managed Care.
A new clinical coverage policy, 1S-5 Genetic Testing for Susceptibility to Breast and Ovarian Cancer, became effective July 1.
Carolina Access Providers who received health equity payments are asked to complete this survey by July 16.
Additional information on prior authorization is available.
Four Months Left to Submit Program Year 2021 Attestations and the Security Risk Analysis.
Updates to Clinical Coverage Policy 10B, Outpatient Specialized Therapies, Independent Practitioners
On July 1, 2021, an amended version of the policy was posted.