Proposed Clinical Coverage Policies for Public Comment
Proposed new or amended Medicaid and NC Health Choice clinical coverage policies are posted for comment throughout the month. Visit the Proposed Medicaid and NC Health Choice Policies for current posted policies and instructions to submit a comment.
As of Nov. 1, 2018, the following NC Medicaid policies are open for public comment:
Topics Related to All Providers
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 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 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.
Claims for balloon sinus ostial dilation billed with modifier 50 (bilateral) have been resulting in an underpayment to providers. The issue has been resolved.
The 2019 ICD-10 update is effective Oct. 1, 2018 through Sept. 30, 2019, for provider use.
If a provider’s enrollment application or Manage Change Request (MCR) does not contain errors, it will process more quickly. NC Medicaid and the NCTracks Enrollment Team frequently share information about commons errors that cause delays in processing applications and MCRs.
Pursuant to Section 6.a. of the NCDHHS Provider Administrative Participation Agreement, providers are required to update their enrollment records in NCTracks within 30 days of a change.
In April 2018, the recredentialing notification and suspension process was modified. The previous rule to extend the recredentialing due date if a Manage Change Request Application is "In Review" has been removed.
Registration is open for several instructor-led training courses for providers that will be held in October 2018.