Blog Entry List

Effective March 23, 2020, if medically necessary, outpatient Respiratory Therapy (RT) services provided through the Independent Practitioner Provider (IPP) program that typically require prior authorization (PA), may be provided to NC Medicaid and NC Health Choice beneficiaries without PA.

The Outpatient Pharmacy point of sale (POS) adult and pediatric clinical edits for behavioral health medications will temporarily suspend effective March 23, 2020. These point of sale edits target dosages exceeding the FDA approved maximum limit and in class therapeutic duplication.  

In response to the anticipated spread of the novel coronavirus (COVID-19) in North Carolina, EviCore, NC Medicaid’s contracted vendor for imaging services, will auto-approve the following chest CT codes effective immediately:

In response to the anticipated spread of the novel coronavirus (COVID-19) in North Carolina, NC Medicaid is adding the following diagnosis code to the list of diagnoses exempt from the annual visit limit:

The Centers for Medicare & Medicaid Services (CMS) has granted NC Medicaid the authority to temporarily modify several Medicaid and NC Health Choice policies retroactive to March 1, 2020, and through the end of federal emergency declaration or when the flexibility is ended by the State or CMS

DHHS will host a question and answer webinar to discuss new guidance for all health providers related to COVID-19 on Tuesday, March 24, 2020, from 5:30-6:30 p.m.

NC DHHS continues to take action to protect the health and safety of our state’s patients and providers during the novel coronavirus (COVID-19) outbreak. NC DHHS received authority under Section 1135 of the Social Security Act to waive certain federal Medicare, Medicaid, CHIP and HIPAA requirements.

NOTE: SPECIAL BULLETIN COVID-19 #8 has been replaced in its entirety by SPECIAL BULLETIN #39: Face-to-Face Provider Site Visits and Fingerprinting Requirements for NC Medicaid Provider Enrollment Temporarily Suspended.

NOTE: SPECIAL BULLETIN COVID-19 #9 has been replaced in its entirety by SPECIAL BULLETIN COVID-19 #34: Telehealth Clinical Policy Modifications - Defin

To ensure beneficiaries continue to receive Medicaid and NC Health Choice services with no interruption or delays due to the COVID-19 outbreak, the disposition for three claim processing edits have been temporarily changed.

Private Duty Nursing - beneficiaries under 21 years of age, Private Duty Nursing - all beneficiaries and Home Health – All Beneficiaries.

The Centers for Medicare & Medicaid Services has granted NC Medicaid the authority to move forward with Home and Community-Based (HCBS) waiver flexibilities requested March 13, 2020. 

This article is a reminder to providers of the process for submitting requests for Disproportionate Share Hospital data. Medicaid and NC Health Choice Providers must request and obtain batch Medicare DSH Recipient Eligibility Verifications and Provider Statistical and Reimbursement reports through NCTracks.

We know these are challenging times and are grateful for the continued support of our partners across the state. There is a wealth of information on the DHHS website and our team is working around the clock to make it as user-friendly as possible.