Blog Entry List
With each prior approval (PA) entry beginning with the third and subsequent benefit periods, providers must fax a copy of the Approval Status Inquiry Form, or the NCTracks Web Submitted Request for Hospice Prior Approval Confirmation Page, to DMA at 919-715-9025. DMA requests that providers include their name and e-mail address on the above forms.
Note: This article was previously published in the September 2017 Medicaid Bulletin. It is being republished with updates.
Effective Feb. 1, 2018, N.C. Medicaid will cover balloon sinus ostial dilatation (BOD) surgery. The BOD policy will outline the new coverage for applicable CPT procedure codes.
The American Medical Association (AMA) publishes an annual Current Procedural Terminology (CPT) manual each fall outlining new, revised, and deleted procedural codes effective January 1 of the following calendar year. (For complete information regarding all code and description changes, refer to the 2018 edition of Current Procedural Terminology.) N.C. Medicaid reviews these codes changes to determine clinical coverage for the Medicaid program.
Effective Oct. 29, 2017, NCTracks will implement a quarterly Maintain Eligibility Process which identifies providers with no claim activity within the past 12 months. The provider must attest electronically in NCTracks to remain active.
The Centers for Medicare & Medicaid Services announced an increase in the Affordable Care Act provider enrollment application fee.
The N.C. Medicaid and N.C. Health Choice (NCHC) application fee is $100, which covers costs associated with processing enrollment applications. The $100 application fee is required for both in-state and border-area (within 40 miles) providers during initial enrollment and when providers complete the five-year reverification process.
The provision of family planning services and family planning-related services has been the sole purpose of the “Be Smart” Family Planning Medicaid program since it started in October 2005, and continued with the CMS approval of the State Plan Amendment in 2014.
Appropriate maternal depression screening is necessary to ensure that postpartum depression is addressed and care is administered in a timely manner to improve quality of care and long-term outcomes for both mother and child. Maternal depression screening identifies mothers who may be suffering from depression and may lead to treatment or discussion of referral strategies for appropriate treatment.
The following new or amended combined N.C. Medicaid and N.C. Health Choice clinical coverage policies are available on DMA’s clinical coverage policy web pages.
Clinical Coverage Policy (CCP) 11B-4, Kidney (Renal) Transplantation, has been revised.
The revisions, which will become effective Feb. 1, 2018, will remove the prior authorization requirement from live donor kidney transplants and reflect coverage based on glomerular filtration rate (GFR) and age, rather than diagnosis.
There are only four months left to submit an attestation for Program Year 2017.
Per Session Law (S.L.) 2015-241, as amended by S.L. 2017-57, North Carolina providers who are reimbursed by the state for providing health care services under N.C. Medicaid and N.C. Health Choice programs must join NC HealthConnex, the state-designated Health Information Exchange.
Registration is open for several instructor-led training courses for providers that will be held in January 2018.
Effective with date of service Oct. 15, 2017, the NC Medicaid Program covers triamcinolone acetonide extended-release injectable suspension, for intra-articular use (Zilretta) for use in the Physician’s Drug Program (PDP) when billed with HCPCS code J3490 - Unclassified drugs. Zilretta is currently commercially available as a single-dose kit containing one vial of Zilretta microsphere powder (32 mg of triamcinolone acetonide), one vial of 5 mL diluent, and one sterile vial adapter.