Topics Related to Hospital Providers

For clarification purposes of information communicated in October 2018 Medicaid Bulletin, please note that effective Oct. 1, 2018 the new 4-digit Long Acting Reversible Contraceptives (LARC) DRG code is not required to be submitted on the claim.

For Inpatient Hospital services the appropriate reimbursement process will begin after the claim has been grouped using the Grouper Software as usual. Either the original maternity DRG, or the LARC will be assigned systematically.

Additional information on prior authorization is available.

Select provider types enrolled in the NC Medicaid Program are required to file annual Medicaid cost reports utilizing cost reporting schedules which are based on approved Medicare cost reporting platforms.

NC Medicaid is implementing time-limited, targeted, enhanced swing bed reimbursement rates to provide additional financial support to hospitals that provide post-acute care services to COVID-19 positive (“COVID+”) Medicaid beneficiaries and non-COVID+ Medicaid beneficiaries transferred from other acute care hospitals as part of a surge response.  

Effective Oct. 1, 2019, two additional ICD-10 codes will be added to the LARC DRG reimbursement retroactive date of Oct. 1, 2018.  

Providers must bill with the following HCPCS code, and the appropriate ICD-10 PCS code on the inpatient hospital claim to receive the LARC DRG reimbursement.

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.

NC Medicaid has instructed Health Management System (HMS) to resume audits of hospital outpatient claims. These reviews are commencing now, as the claims adjustment reason code issue has been resolved. NC Medicaid appreciates the assistance of the provider workgroups to identify issues and confirm improvements once system enhancements were completed. HMS will also continue its other assigned third-party liability reviews.

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.