These guidelines assist with claim submissions for dually eligible beneficiaries. This information addresses situations known to affect a significant number of claims. It is not feasible to provide an all-inclusive list due to the variable nature of the programs.
Blog Entry List
Medicaid’s Third-Party Liability contractor, Health Management Systems, Inc., will implement a Commercial Insurance Disallowance project to streamline North Carolina’s coordination of benefits and direct billing processes. The expected date for implementation is Oct. 1, 2018.
On June 1, 2018, hospitals, physicians, physician assistants and nurse practitioners with an electronic health record system must have initiated a connection to NC HealthConnex, North Carolina’s designated statewide health information exchange network.
Effective Jan. 1, 2018, North Carolina Medicaid increased the rates for mammography procedure codes 77065, 77066, and 77067. Medicaid has identified the claims that have been affected by this change.
Effective July 1, 2018, North Carolina Medicaid has revised Clinical Coverage Policy (CCP) 1-O-3, Keloid Excision and Scar Revision, to clarify the procedure for proper submission of preoperative photographs to CSRA as part of the prior approval process.
Clinical Coverage Policy 11A-15, Hematopoietic Stem-Cell Transplantation for Solid Tumors of Childhood, has been revised.
Effective Oct. 1, 2017, Clinical Coverage Policy 2B-1, Nursing Facility Services, was revised in accordance with 42 CFR 483 Subpart B.
Centers for Medicare & Medicaid Services (CMS) is overhauling and streamlining the Electronic Health Record (EHR) Incentive Program. The goal is to move the program beyond requirements for meaningful use (MU) to increase focus on interoperability and improving patient access to health information.
The following new or amended combined North Carolina Medicaid and NC Health Choice clinical coverage policies are available on Medicaid’s Clinical Coverage Policy web pages.
Registration is open for the June 2018 instructor-led provider training courses listed below. Slots are limited.
Note: This article was originally published as a Special Bulletin in January 2018, with updates regarding clinical pharmacist practitioners.
Providers must submit a Fingerprinting Criminal Background Check application within 30 days of receiving the request notification to avoid being terminated for cause.
Beginning Sept.1, 2018, adult care home and nursing home Pre-Admission Screening and Resident Review submissions through Provider Link will no longer be accepted. PASRR submissions will only be accepted via NC Medicaid Uniform Screening Tool.
Effective July 1, 2018, North Carolina Medicaid and NC Health Choice behavioral health providers who were added to NCTracks via the Local Management Entity/Managed Care Organization Provider Upload process must complete reverification. Providers identified are being notified of their reverification due date via NCTracks communication to the Office Administrator on record.
The procedure code list for nurse practitioners (NPs) and physician assistants (PAs) has been updated recently to include additional NP and PA taxonomies.