Claims for balloon sinus ostial dilation billed with modifier 50 (bilateral) have been resulting in an underpayment to providers. The issue has been resolved.
Blog Entry List
Effective with date of service Sept. 5, 2018, the Medicaid and NC Health Choice programs cover antihemophilic factor (recombinant) PEGylated-aucl, for intravenous use (Jivi) for use in the Physician's Drug Program (PDP) when billed with HCPCS code J7199-Hemophilia clotting factor, not otherwise classified.
Effective with date of service Sept. 5, 2018, the Medicaid and NC Health Choice programs cover patisiran lipid complex injection, for intravenous use (Onpattro) for use in the Physicians Drug Program (PDP) when billed with HCPCS code J3490 - Unclassified drugs.
Effective with date of service Aug. 17, 2018, the Medicaid and NC Health Choice programs cover plazomicin injection, for intravenous use (Zemdri) for use in the Physician's Drug Program when billed with HCPCS code J3490-Unclassified drugs.
Effective for dates of service on or after Oct. 1, 2018, the following DRG classifications specific to LARCs will be added to the current Grouper 36 version within NCTracks for claims reimbursement.
The Department of Health and Human Services is implementing the Referral Screening Verification Process for individuals being considered for admission to an Adult Care Home effective Nov. 1, 2018.
Personal Care Services (PCS) regional training sessions will be held Oct. 18-Nov. 1, 2018.
Effective Sept. 15, 2018, Clinical Coverage Policy 10A, Outpatient Specialized Therapies, was updated to increase therapy visit limits for recipients 21 years of age and older.
Providers are reminded that NC Medicaid flexibilities due to Hurricane Florence end on Oct. 5, 2018. For additional information, please refer to the Sept. 27, 2018 Special Medicaid Bulletin.
NCTracks Call Center, 1-800-688-6696
NC Medicaid and Health Choice will reimburse providers for medically necessary drugs and services and equipment and supplies provided during the Hurricane Florence emergency without prior approval from Sept. 14 through Oct. 5, 2018.
Residents in 27 counties impacted by Hurricane Florence can apply for help buying food through the Disaster Supplemental Nutrition Assistance Program, or "D-SNAP."
NC Medicaid Flexibilities due to Hurricane Florence Extended through Sept. 28, 2018
Per the Sept. 12, 2018, South Carolina Department of Health and Human Services (SCDHHS) Medicaid Bulletin, SCDHHS will, in good faith, reimburse North Carolina qualified providers not currently enrolled with or otherwise pre-approved by the South Carolina Medicaid program for medically necessary and time-sensitive services rendered to South Carolina Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries.
Effective Aug. 1, 2018, the Division of Medical Assistance (DMA) and Division of Health Benefits (DHB) combined into one division called the NCDHHS Division of Health Benefits.
On April 2, 2018, General Dynamics Information Technology acquired CSRA Inc. CSRA is now "CSRA State and Local Solutions LLC, A General Dynamics Information Technology Company," or simply "GDIT."