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.
You are receiving this notice in regard to Hospice claims that were adjudicated in NCTracks beginning Jan. 1, 2016.
The Contract for Prepaid Health Plan Services (the State Contract) between the Department of Health and Human Services (the Department) and the selected Medicaid Managed Care plans (i.e., Prepaid Health Plans or PHPs) indicates that contracts between PHPs and providers shall comply with the terms of the State Contract and must be approved by the Department.
NC-MIPS is Open for Program Year 2019. The NC Medicaid EHR Incentive Payment System (NC-MIPS) is only accepting Program Year 2019 Stage 3 Meaningful Use (MU) attestations.
New or amended clinical coerage policies are available on NC Medicaid's website.
Registration is open for the July 2019 instructor-led provider training courses. Slots are limited.
Effective July 1, 2019, NC Medicaid will make changes to the North Carolina Medicaid and NC Health Choice Preferred Drug List.
Effective with date of service April 4, 2019, the North Carolina Medicaid and NC Health Choice programs cover coagulation factor Xa (recombinant), inactivated-zhzo lyophilized powder for solution for intravenous injection (Andexxa) for use in the Physician Administered Drug Program when billed with HCPCS code J3590 - Unclassified biologics.
Effective with date of service April 11, the North Carolina Medicaid and NC Health Choice programs cover romosozumab-aqqg injection, for subcutaneous use (Evenity) for use in the Physician Administered Drug Program when billed with HCPCS code J3590 - Unclassified biologics.
Effective with date of service April 5, 2019, the North Carolina Medicaid and NC Health Choice programs cover trastuzumab and hyaluronidase-oysk injection, for subcutaneous use (Herceptin Hylecta) for use in the Physician Administered Drug Program when billed with HCPCS code J9999 - Not otherwise classified, antineoplastic drugs.
On June 1, 2019, an amended version of Clinical Coverage Policy 10B, Independent Practitioners, was posted to the North Carolina Medicaid website. The following updates were made in accordance with State Plan Amendment (SPA) NC 18-0005 which allowed an expansion of the universe of documentation that a Local Education Agency (LEA) can use as a basis for providing school-based health services from beyond a student beneficiary’s Individualized Education Program (IEP) to also include the Individual Family Service Plan (IFSP), Individual Health Plan (IHP), Behavior Intervention Plan (BIP) or 504 Plan.
Clinical review is not required for North Carolina Medicaid and NC Health Choice hospice services until after the completion of the first and second 90-day benefit period.
Due to the implementation of Centers for Medicare and Medicaid Services (CMS) FY 2016 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements Final Rule, NC Medicaid made policy and system changes to allow for the use of two-tier hospice fee schedules effective Jan. 1, 2016.
NC Medicaid has received approval from the Centers for Medicare and Medicaid Services (CMS) to increase rates for Evaluation and Management (E&M) procedure codes, as defined in Section 1202 of the Affordable Care Act (ACA) and paid to primary care physicians, nurse practitioners and physician assistants. In addition to the ACA primary care practitioners, obstetricians and gynecologists will also be included as primary care physicians.
The Contract for Prepaid Health Plan Services (the State Contract) between the Department of Health and Human Services (the Department) and the selected Medicaid Managed Care plans (i.e., Prepaid Health Plans or PHPs) indicates that contracts between PHPs and providers shall comply with the terms of the State Contract and must be approved by the Department.