Registration is open for several instructor-led training courses for providers that will be held in May 2018. Slots are limited.
Blog Entry List
Effective May 1, 2018, North Carolina Medicaid will cover digital breast tomosynthesis (3D tomosynthesis) for both screening and diagnostic mammography.
Effective May 1, 2017, new pharmacy point of sale clinical edits for behavioral health medications were applied for pediatric and adult beneficiaries. Note: This article was originally published in February 2017 Medicaid Bulletin.
Effective May 1, 2018, Clinical Coverage Policy 1C-1, Podiatry Services, is revised to include annual updates to International Classification of Diseases (ICD-10-CM) codes.
The implementation of ICD-10-CM allows specificity for accurate coding, resulting in greater justification of medical necessity. A provider’s documentation must include details to completely depict the nature of a beneficiary’s diagnosis and procedures performed.
Note: This article was previously published in the September 2017 Medicaid Bulletin. It is republished with updates regarding edit disposition.
Effective Oct. 29, 2017, the NC Department of Health and Human Services (DHHS) validates through NCTracks that the billing provider’s address submitted on the claim corresponds to the location listed on the provider record for the dates of service submitted. The billing provider address, city, state and zip code (first five digits) on all North Carolina Medicaid and NC Health Choice claims must match exactly with the corresponding information on the provider record. (The match is not case sensitive.)
Per Session Law (S.L.) 2015-241, as of June 1, 2018, hospitals, mid-level physicians and nurse practitioners who currently have an electronic health record system must be connected to NC HealthConnex to continue to receive payments for Medicaid and NCHC services.
By July 1, 2018, Medicaid behavioral health providers added to NCTracks by their current Local Management Entity/Managed Care Organization Provider Upload Process must complete re-verification.
The Department of Health and Human Services, Division of Medical Assistance, provides notice of its intent to amend the Medicaid State Plan to increase the rates for metabolic formula – Durable Medical Equipment.
Topics include: list of providers due for re-credentialing, changes to re-credentialing process and changes to ongoing verification process.
Effective Feb. 1, 2018, Clinical Coverage Policy 1A-42, Balloon Ostial Dilation, was revised to include new coverage of CPT code 31298 (balloon dilation of frontal and sphenoid sinus).
In accordance with 10A NCAC 22J .0106, a provider may refuse to accept a patient as a Medicaid patient and bill the patient as a private pay patient only if the provider informs the patient that the provider will not bill Medicaid for any services, but will charge the patient for all services provided.
As previously communicated, Reimbursement Rate Increase, North Carolina Medicaid retroactively increased the rate for Personal Care Services and the Community Alternatives Program for Children.
The Community Alternatives Program for Disabled Adults (CAP/DA) Waiver allows Adult Day Health (ADH) centers licensed to provide overnight respite to be providers of CAP/DA Institutional Respite.
The NC Division of Medical Assistance (DMA) has received calls concerning claim denials for some services provided by nurse practitioners (NPs) and physician assistants (PAs).