The NC Medicaid EHR Incentive Program is no longer accepting Program Year 2018 attestations. Program Year 2018 attestations are being processed in the order they were received. Attestations received in April may take up to eight weeks to be processed from the date the signed attestation was received.
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Effective Feb. 25, 2019, the North Carolina Medicaid and NC Health Choice programs cover caplacizumab-yhdp for injection, for intravenous or subcutaneous use (Cablivi) for use in the Physician Administered Drug Program when billed with HCPCS code J3590 - Unclassified biologics.
Effective March 1, 2019, the North Carolina Medicaid and NC Health Choice programs cover dexamethasone intraocular suspension 9%, for intraocular administration (Dexycu) for use in the Physician Administered Drug Program when billed with HCPCS code J1095 - Injection, dexamethasone 9%, intraocular, 1 microgram.
The Food and Drug Administration (FDA) previously approved a Risk Evaluation and Mitigation Strategies (REMS) for Mifeprex (mifepristone) to mitigate the risk of serious adverse events. After reviewing the supplemental application, the FDA determined that a REMS is necessary to ensure the safe use of Mifeprex.
NC Medicaid has received calls concerning claim denials for some services provided by nurse practitioners (NPs) and physician assistants (PAs).
NC Medicaid has adopted the American Medical Association's new Current Procedural Terminology® (CPT) Category I codes for Research Based Behavioral Health Treatment, effective for dates of service on or after Jan. 1, 2019.
In response to provider requests and to align more closely with Medicare coverage for Independent Diagnostic Testing Facilities (IDTF), effective June 1, 2019, NC Medicaid will add coverage for additional procedure codes outlined in the attached document.
To minimize the administrative burden on providers as NC Medicaid transitions to managed care, the Provider Data Contractor (PDC) will supplement the state’s existing provider credentialing data to the Prepaid Health Plans (PHPs). This will support the PHP’s ability to make quality determinations during Medicaid Managed Care provider network contracting activities. The PHPs will make their quality determination policy public once approved by NC Medicaid.
Recommended updates to the NC Medicaid and Health Choice Preferred Drug List (PDL) as approved by the NC Pharmacy and Therapeutics (P&T) Committee and the NC Physician Advisory Group (PAG) were posted for the required 45-day public comment period on Apr. 2, 2019.
The Department recognizes that the move to managed care may impose additional administrative burdens and program complexity to the work NC providers already do. To mitigate the administrative burden on providers as NC Medicaid transitions to managed care, the Department procured a contractor to supplement the state’s existing provider enrollment data. This data will be combined with provider enrollment information NC Medicaid has on file to support the Prepaid Health Plans’ (PHPs’) ability to help determine which providers to contract with.
Please post an English and Spanish version of the “Notice Of Your Rights Under Hawkins v. Cohen” in a prominent location for at least 180 calendar days.
The Payment Error Rate Measurement (PERM) is an audit program developed and implemented by the Centers for Medicare & Medicaid Services (CMS) as required by the Improper Payments Information Act (IPIA) of 2002. It is used nationwide to review beneficiary eligibility determinations and claims payments made by North Carolina Medicaid and NC Health Choice to ensure that states only pay for appropriate claims. A national report is distributed outlining the various error rates among states.
New or amended clinical coverage policies are available on NC Medicaid’s website.
April is the last month to submit an attestation for Program Year 2018. The NC Medicaid EHR Incentive Payment System (NC-MIPS) will close for Program Year 2018 at midnight on Apr. 30, 2019. After that no changes can be made. Eligible professionals (EP) are strongly advised to review their attestation and documentation for accuracy and completeness
Beginning in April, participating health care providers in the state-designated health information exchange (HIE), NC HealthConnex, will be moving to a new HIE platform.