Blog Entry List
Effective with date of service Nov. 11, 2019, the NC Medicaid and NC Health Choice programs cover luspatercept-aamt for injection, for subcutaneous use (Reblozyl) for use in the Physician Administered Drug Program when billed with HCPCS code J3590 - Unclassified biologics.
Pegfilgrastim-bmez Injection, for Subcutaneous Use (Ziextenzo™) HCPCS Code J3590: Billing Guidelines
Effective with date of service Nov. 8, 2019, the NC Medicaid and NC Health Choice programs cover pegfilgrastim-bmez injection, for subcutaneous use (Ziextenzo) for use in the Physician Administered Drug Program when billed with HCPCS code J3590 - Unclassified biologics.
NC Medicaid has received calls concerning claim denials for some services provided by nurse practitioners and physician assistants. NC Medicaid has provided instructions to NCTracks to update the claims processing system. The following procedure code list was recently updated to include additional NP and PA taxonomies.
On Dec. 11, 2019, DHHS released for comments the draft provider manual and application process for care management for people with Behavioral Health and Intellectual and Developmental Disabilities (I/DDs) who will be served by Tailored Plans. The Department is revising the draft manual and will be issuing an updated version shortly.
The following new or amended clinical coverage policies are available on the NC Medicaid Clinical Coverage Policies web page.
Section 6401(a) of the Affordable Care Act requires the Secretary to impose a fee on each "institutional provider of medical or other items or services and suppliers." Based upon provisions of the ACA, this fee will vary from year to year based on adjustments made pursuant to the Consumer Price Index for Urban Areas.
The Foundation for Health Leadership and Innovation's Center of Excellence for Integrated Care, in partnership with UNC-Chapel Hill School of Nursing, is conducting a short survey.
NC-MIPS is Open for Program Year 2019, Reminder from CMS Regarding Objective 6 and Objective 7, Clarification from CMS Regarding Objective 5 Measure 1: Patient Electronic Access and general reminders.
The following new or amended clinical coverage policies are available on the NC Medicaid Clinical Coverage Policies web page.
New or amended clinical coverage policies are available on NC Medicaid's website.
Effective with date of service Jan. 1, 2020, the American Medical Association (AMA) added new CPT codes, deleted others and changed the descriptions of some existing codes.
North Carolina Medicaid’s third-party liability (TPL) contractor, Health Management System, Inc. (HMS), will implement the Commercial Insurance (CI) disallowance project to streamline North Carolina’s coordination of benefits direct billing processes. The expected implementation date is Jan. 1, 2020. This will result in higher recoveries for the state and higher pay rates for providers. HMS will assist Medicaid providers by identifying and validating other (non-Medicaid) health coverage so that providers can maximize payment rates by billing commercial rates rather than Medicaid rates.
Effective with date of service Nov. 11, 2019, the North Carolina Medicaid and NC Health Choice programs cover rituximab-abbs injection, for intravenous use (Truxima) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code Q5115 - Injection, rituximab-abbs, biosimilar, (Truxima), 10 mg.
Effective with date of service Nov. 7, 2019, the North Carolina Medicaid and NC Health Choice programs cover trastuzumab-dkst for injection, for intravenous use (Ogivri) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code Q5114 - Injection, Trastuzumab-dkst, biosimilar, (Ogivri), 10 mg.