Author: NC Medicaid Provider Reimbursement, 919-814-0060
As previously communicated in the July 2018 North Carolina Medicaid Special Bulletin, the NPI Exemption List will cease Aug. 31, 2018, for Clinical Pharmacist Practitioners (CPPs), Residents and Interns. CPPs will be able to enroll in Medicaid through NCTracks as an ordering, prescribing, referring (OPR) or rendering provider working under the direction or supervision of a licensed physician. CPPs can submit claims under the taxonomy code 1835P0018X effective July 29, 2018.
In accordance with the North Carolina State Plan, Section 4.19-B, Section 5, Page 1g, CPPs are reimbursed at the lower of usual and customary charges or the appropriate fee from the North Carolina Medicaid Clinical Pharmacist Practitioner Services Fee Schedule. The Fee Schedule is posted on the North Carolina Medicaid website prior to the effective date at https://medicaid.ncdhhs.gov/providers/fee-schedule-index
Claims submitted prior to July 29, 2018, with a CPP’s NPI and taxonomy as the billing provider will be denied with Explanation of Benefits (EOB) 01877- PROVIDER IS NOT AUTHORIZED TO ACT AS A BILLING PROVIDER.
Providers with questions regarding the Fee Schedule may contact Medicaid Provider Reimbursement.