Effective with date of service June 20, 2019, the North Carolina Medicaid and NC Health Choice programs cover dexamethasone ophthalmic insert 0.4 mg, for intracanalicular use (Dextenza) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J3490 - Unclassified drugs.
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Effective with date of service June 11, 2019, the North Carolina Medicaid and NC Health Choice programs cover polatuzumab vedotin-piiq for injection, for intravenous use (Polivy) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J9999 - Not otherwise classified, antineoplastic drugs.
Effective with date of service Aug. 1, 2019, the North Carolina Medicaid and NC Health Choice programs cover infliximab-abda for injection, for intravenous use (Renflexis) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code Q5104 - Injection, infliximab-abda, biosimilar, (renflexis), 10 mg.
NC Medicaid has received calls concerning claim denials for some services provided by nurse practitioners (NPs) and physician assistants (PAs). NC Medicaid has provided instructions to NCTracks on updating the claims processing system.
The Department of Health and Human Services (DHHS) will extend open enrollment for Medicaid beneficiaries and move to a statewide transition to managed care on Feb. 1, 2020.
Clinical Coverage Policy 1A-12 Breast Surgeries has been updated to reflect changes throughout the policy.
Effective July 1, 2019, providers may request, perform and bill for low-dose lung cancer screening utilizing healthcare common procedure coding system (HCPCS) code G0297.
Policies (9) Outpatient Pharmacy Program and (8F) Research-based Behavioral Health Treatment (RB-BHT) for Autism Spectrum Disorder (ASD) are available on NC Medicaid's website.
The sterilization consent form found on the U.S. Department of Health & Human Services (HHS) website has been updated.
In accordance with 2 CFR part 200, subpart F, the North Carolina Office of the State Auditor (OSA) annually conducts the State Single Audit and accordingly selects a sample of NC Medicaid claims to determine if claims paid by the state were properly supported. Some claims documentation submitted were determined to be inadequate to support payment for services billed and were deemed an error.
The Americans with Disabilities Act (ADA), and other federal laws, prohibit discrimination and seek to ensure equal opportunity for persons with disabilities in employment, state and local government services, public accommodations, commercial facilities and transportation.
Effective July 28, 2019, the presumptive eligibility provider enrollment process will be transitioned from NC Medicaid to NCTracks. NCTracks will assume the enrollment process for providers of presumptive eligibility for pregnant women and hospital providers of presumptive eligibility for Medicaid programs.
Effective July 28, 2019, an expedited disaster relief provider enrollment application process will be available during times of disaster such as a State of Emergency. This abbreviated enrollment application will collect limited information to enroll a provider for a limited time (120 days) and will be available to in-state, out-of-state (OOS) and border providers that are not yet enrolled in NC Medicaid, including individual providers and organizations.
The NC Medicaid EHR Incentive Payment System (NC-MIPS) is only accepting Program Year 2019 Stage 3 Meaningful Use (MU) attestations.
Supporting beneficiaries in their transition between the current fee-for-service delivery system and NC Medicaid Managed Care is called transition of care. The transitional period surrounding the launch of Medicaid Managed Care is referenced as crossover.
DHHS will initiate crossover-specific activities in August 2019 and will continue these activities through April 2020.