The following new or amended clinical coverage policies are available on the Clinical Coverage Policies web page on NC Medicaid’s website.
Topics Related to All Providers
NC Medicaid has updated its Appendix K to extend flexibilities on how Medicaid providers and beneficiaries access and receive home- and community-based services through CAP/C, CAP/DA, NC Innovations waiver and Traumatic Brain Injury waiver.
In addition to the NC Medicaid Provider webpage, Medicaid and NC Health Choice providers now have a supplemental resource to research their questions and submit inquiries.
The Department released the Advanced Medical Home Provider Manual 2.0 today. This version reflects program expectations as well as recent program modifications and changes that impact provider contracts.
NC Medicaid has released the NC Department of Health and Human Services Transition of Care Policy, which outlines NC Medicaid's vision on the process of assisting a beneficiary through the transition between health plans or between service/payment delivery systems.
Providers have until April 30, 2021, to submit a complete and accurate attestation for Program Year 2020. After that no changes can be made.
Effective with date of service Jan. 1, 2021, the Centers for Medicare & Medicaid Services has identified new CPT and HCPCS codes as separately reimbursable in the ambulatory surgery setting.
CPT Code 87428 (related to COVID-19) was improperly defined in a previous Bulletin and is being correctly defined here.
To continue supporting providers interested in obtaining certification as an Advanced Medical Home Plus (AMH+) practice or Care Management Agency (CMA), the Round 1 application deadline is being extended from March 1, 2021 to June 1, 2021.
NC Medicaid is initiating its final phase of reconciling projected versus actual testing cost submission activity for nursing home staff testing payments authorized under Secretarial Orders 2 and 4 on March 1, 2021.