North Carolina’s Department of Health and Human Services, Division of Health Benefits (DHB) has contracted with Health Management Systems (HMS) to conduct Overpayment Recovery Reviews for Medicaid/Health Choice recipients.
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Psychiatric collaborative care management services must be rendered under the direction of a treating physician or non-physician practitioner, typically in a primary care setting. These services are rendered when a beneficiary has a diagnosed psychiatric disorder and requires assessment, care planning and provision of brief interventions.
Bone Mass Measurement policy has been updated to reflect the addition of anorexia nervosa as an approved diagnosis for beneficiaries with other conditions or currently receiving medical therapies known to cause low bone mass.
New or amended clinical coverage policies are available on Telemedicine and Telepsychiatry, Outpatient Specialized Therapies and Bone Mass Measurement
The NC Medicaid EHR Incentive Program is no longer accepting Program Year 2018 attestations. Program Year 2018 attestations are being processed in the order they were received. Attestations received in April may take up to eight weeks to be processed from the date the signed attestation was received.
Effective Feb. 25, 2019, the North Carolina Medicaid and NC Health Choice programs cover caplacizumab-yhdp for injection, for intravenous or subcutaneous use (Cablivi) for use in the Physician Administered Drug Program when billed with HCPCS code J3590 - Unclassified biologics.
Effective March 1, 2019, the North Carolina Medicaid and NC Health Choice programs cover dexamethasone intraocular suspension 9%, for intraocular administration (Dexycu) for use in the Physician Administered Drug Program when billed with HCPCS code J1095 - Injection, dexamethasone 9%, intraocular, 1 microgram.
The Food and Drug Administration (FDA) previously approved a Risk Evaluation and Mitigation Strategies (REMS) for Mifeprex (mifepristone) to mitigate the risk of serious adverse events. After reviewing the supplemental application, the FDA determined that a REMS is necessary to ensure the safe use of Mifeprex.
NC Medicaid has received calls concerning claim denials for some services provided by nurse practitioners (NPs) and physician assistants (PAs).
NC Medicaid has adopted the American Medical Association's new Current Procedural Terminology® (CPT) Category I codes for Research Based Behavioral Health Treatment, effective for dates of service on or after Jan. 1, 2019.
In response to provider requests and to align more closely with Medicare coverage for Independent Diagnostic Testing Facilities (IDTF), effective June 1, 2019, NC Medicaid will add coverage for additional procedure codes outlined in the attached document.
To minimize the administrative burden on providers as NC Medicaid transitions to managed care, the Provider Data Contractor (PDC) will supplement the state’s existing provider credentialing data to the Prepaid Health Plans (PHPs). This will support the PHP’s ability to make quality determinations during Medicaid Managed Care provider network contracting activities. The PHPs will make their quality determination policy public once approved by NC Medicaid.
Recommended updates to the NC Medicaid and Health Choice Preferred Drug List (PDL) as approved by the NC Pharmacy and Therapeutics (P&T) Committee and the NC Physician Advisory Group (PAG) were posted for the required 45-day public comment period on Apr. 2, 2019.
The Department recognizes that the move to managed care may impose additional administrative burdens and program complexity to the work NC providers already do. To mitigate the administrative burden on providers as NC Medicaid transitions to managed care, the Department procured a contractor to supplement the state’s existing provider enrollment data. This data will be combined with provider enrollment information NC Medicaid has on file to support the Prepaid Health Plans’ (PHPs’) ability to help determine which providers to contract with.
Please post an English and Spanish version of the “Notice Of Your Rights Under Hawkins v. Cohen” in a prominent location for at least 180 calendar days.