Topics Related to All Providers
Every year, in accordance with 2 CFR part 200, subpart F, the NC Office of the State Auditor selects a sample of North Carolina Medicaid and NC Health Choice claims to review to determine the state’s compliance with federal and state regulations for claims paid in the prior state fiscal year, which runs from July 1 to June 30.
Per Session Law (S.L.) 2015-241, as of June 1, 2018, hospitals, mid-level physicians and nurse practitioners who currently have an electronic health record system must be connected to NC HealthConnex to continue to receive payments for North Carolina Medicaid and NC Health Choice services.
The following new or amended combined North Carolina Medicaid and NC Health Choice (NCHC) clinical coverage policies are available on Medicaid’s clinical coverage policy web pages.
April is the last month to submit an attestation for the NC Medicaid Electronic Health Record Incentive Program for Program Year 2017. North Carolina’s Medicaid EHR Incentive Payment System will close for Program Year 2017 at midnight on April 30, 2018.
Effective April 1, 2018, North Carolina Medicaid will make several changes to the Medicaid and NC Health Choice Preferred Drug List (PDL):
In response to provider feedback, the use of the NPI Exemption List for residents and interns enrolled in graduate dental and medical programs, and area health education centers will be extended from Jan. 31, 2018 to April 30, 2018. Note: This article was originally published as a Special Bulletin in January 2018.
This article assists providers to identify and report potential report fraud, waste, or abuse.
The Payment Error Rate Measurement (PERM) audit calculates error rates for Medicaid, Children’s Health Insurance Programs (CHIP) and Managed Care on a three-year cycle for the Centers for Medicare & Medicaid Services (CMS). The error rates are based on reviews of the fee-for-service (FFS), managed care, and eligibility components of those three programs in the fiscal year under review.
Note: NC Health Choice (NCHC) is the state’s CHIP program.
Note: NC Health Choice (NCHC) is the state’s CHIP program.
This article was updated on May 10, 2018. Topics include: list of providers due for re-credentialing, changes to re-credentialing process, and changes to ongoing verification process.
Registration is open for the March 2018 instructor-led provider training courses listed below. Slots are limited.