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Special Bulletin: Optical Services Covered for Adult Medicaid Beneficiaries Effective Jan. 1, 2019

Thursday, December 20, 2018

Effective Jan. 1, 2019, optical services shall be covered for adult Medicaid beneficiaries in accordance with S. L. 2018-97, Part III, Section 11H.13.(c). However, Centers for Medicare and Medicaid Services (CMS) approval of the corresponding State Plan Amendment is pending.

  • Optical services are routine eye exams and visual aids (prescription eyeglasses and medically necessary prescription contact lenses). All visual aids require prior approval through NCTracks.
  • Providers may provide routine eye exams and visual aids, effective Jan. 1, 2019. However, NC Medicaid cannot pay claims prior to CMS approval of the State Plan Amendment, which is expected in January 2019.
  • NC Medicaid will notify providers when CMS approves the State Plan Amendment, at which time providers may submit claims for optical services rendered on or after Jan. 1, 2019. Payment for adult optical services will be retroactive to date of service Jan. 1, 2019.
  • The draft Clinical Coverage Policy 6B, Routine Eye Examination and Visual Aids for Beneficiaries 21 Years of Age and Older is posted through Jan. 4, 2019, for public comments.

New frames listed in the Nash Optical Plant Frame Catalog will not be available in the NCTracks frame dropdown selection until Jan. 28, 2019. This does not prevent providers from submitting eyeglasses prior approval requests in NCTracks beginning Jan. 1, 2019.

  • Between Jan. 1, 2019 and Jan. 28, 2019, providers must click on ‘Other’ in the frame dropdown and a free-form text window will appear.
  • The provider must type the frame model or number, bridge size and color in this ‘Other’ free-form text field.
  • Effective Jan. 28, 2019, all new frames will be available in the dropdown selection.
  • Providers may contact the Nash Optical Plant at 888-388-1353 for an updated frame catalog.

For more information, please refer to the draft Clinical Coverage Policy 6B, Routine Eye Examination and Visual Aids for Beneficiaries 21 Years of Age and Older.

Providers with questions should contact the NCTracks Call Center at 800-688-6696 or NCTracksprovider@nctracks.com.

Author: 
NCTracks, 800-688-6696