Blog Entry List
The PDM/CVO solution will consolidate provider data management and coordinate provider enrollment, credentialing, and ongoing data maintenance.
Includes medical and pharmacy prior authorizations, out of network provider rates and rules, and primary care provider changes
Providers should review Clinical Coverage Policy 2A-1 for information on Hospital Observation
Usage of the Nicotine Replacement Therapy Protocol is Eligible for Clinical Services Reimbursement to Pharmacies.
Members may now select to receive Tailored Care Management from a provider with Transition to Community Living Distinction.
Feedback Requested on Proposed Approach
To support the SNF and ICF-IID reporting and collection of provider healthcare assessment data.
Expanding Pilot Eligibility to Members in NC Medicaid Direct in Pilot Regions
Billing Requirements for Medicaid Direct Providers
Look for details on training in June related to these changes.
States must revalidate the enrollment of all providers at least every five years to ensure the information on record is accurate and current.
Forum to be held Tuesday, June 25 in Concord.
The audit will sample fee-for-service claims collected for a full year – July 1, 2024, through June 30, 2025.
New separately reimbursable CPT codes in the ambulatory surgery setting