Effective with date of service Jan. 1, 2019, the following dental procedure codes were added for the NC Medicaid and Health Choice Dental Programs. These additions are a result of the Current Dental Terminology (CDT) 2019 American Dental Association (ADA) code updates. Clinical Coverage Policy 4A, Dental Services will be updated to reflect these changes.
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NC Medicaid received approval from CMS for the State Plan Amendment for Adult Optical Services. Effective Feb. 10, 2019, providers may bill for routine eye exams and visual aids for adult Medicaid beneficiaries with dates of service on or after Jan. 1, 2019.
Under the MQB Medicare Eligibility Codes, Medicaid pays only for Medicare Part B premiums or premiums, deductibles, and coinsurance for charges covered by Medicare. Routine eye exams, refraction only and visual aids are not covered by Medicare for MQB beneficiaries. Therefore, MQB beneficiaries are not eligible for Medicaid optical services.
There are only three months left to submit an attestation for Program Year 2018. Providers have until Apr. 30, 2019 to submit a complete and accurate attestation for Program Year 2018.
Registration is open for the February 2019 instructor-led provider training courses listed below. Slots are limited. WebEx courses can be attended remotely from any location with a telephone, computer and internet connection. Please note that the WebEx information has changed.
NC Medicaid has completed updating endoscopy codes in NCTracks, aligning base codes with related procedures in the same family as well as creating three new endoscopy families in NCTracks.
Effective Jan. 27, 2019, abandoned applications are subject to new rules in NCTracks. While the process for addressing incomplete applications will not change, the timeframes allowed for the submission of documentation are revised.
There has been some confusion over the difference between the currently enrolled provider (CEP) registration and the office administrator (OA) change process. To understand which you may need to use, please see the explanations below.
The sterilization consent form found on the U.S. Department of Health & Human Services (HHS) website has been updated.
The following new or amended clinical coverage policies are available on NC Medicaid’s website. These policies supersede previously published policies and procedures.
Out-of-state providers, including border-area providers, must be enrolled in Medicare or their home-state Medicaid program to enroll in NC Medicaid and Health Choice programs.
For clarification purposes of information communicated in October 2018 Medicaid Bulletin, please note that effective Oct.
A contract has been awarded to Wipro Infocrossing to serve as the Provider Data Contractor (PDC), as NC Medicaid transitions to Managed Care.
The following new or amended clinical coverage policies are available on NC Medicaid’s clinical coverage policies web page:
As a reminder, providers are to request and obtain proper prior authorization before services are scheduled or rendered. Contractually, GDIT has five business days (excluding holidays and weekends) to process a medical PA request once all required information is obtained. Pharmacy PAs are processed within 24 hours. Medical necessity cannot be determined with a partial or incomplete clinical picture.