Effective with date of service May 17, 2021, Medicaid and NC Health Choice cover dostarlimab-gxly injection.
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Effective with date of service May 11, 2021, Medicaid and NC Health Choice cover loncastuximab tesirine-lpyl for injection, for intravenous use (Zynlonta).
Effective July 29, 2021, Session Law 2021-62 (NC Senate Bill 594), repeals portions of the 2020 COVID-19 Recovery Act that permitted the temporary lifting of certain enrollment requirements for providers enrolling in NC Medicaid during the global healthcare emergency.
This Bulletin includes key milestone dates for NC Medicaid Managed Care, Provider Playbook updates, prior authorization updates, contracting reminders, information about health plan events, the provider ombudsman and upcoming AHEC events and webinars. It also includes information about the Provider and Health Plan Lookup Tool, PHP Quick Reference Guide and the NC Medicaid Help Center.
This is a reminder to include taxonomy codes when submitting claims to PHPs, either by individual providers or through a trading partner.
This Special Bulletin is being released to inform NC Medicaid providers of COVID-19 rate reimbursement that providers will receive from Prepaid Health Plans (PHPs) under NC Medicaid Managed Care.
ADDENDUM to Special Bulletin #168: The addendum was updated to include information regarding guidance on billing and coding criteria, guidance for parents, counseling methods, reimbursement ranges and the time frame during which the code is valid.
A new clinical coverage policy, 1S-5 Genetic Testing for Susceptibility to Breast and Ovarian Cancer, became effective July 1.
Additional information on prior authorization is available.
Carolina Access Providers who received health equity payments are asked to complete this survey by July 16.
Four Months Left to Submit Program Year 2021 Attestations and the Security Risk Analysis.
Updates to Clinical Coverage Policy 10B, Outpatient Specialized Therapies, Independent Practitioners
On July 1, 2021, an amended version of the policy was posted.
The goal for Day One is that people get the care they need and providers get paid.
NC Medicaid wants to ensure that during the transition to NC Medicaid Managed Care that Medicaid beneficiaries receive the care they need as scheduled prior to July 1.
NC Medicaid is extending COVID-19 temporary provider rate increases for all providers except hospitals and clinical coverage policies through July 31, 2021.