SPECIAL BULLETIN COVID-19 #165: Update to Approved Vaccines Covered by NC Medicaid
The American Rescue Plan Act that was recently enacted includes several changes to COVID-19 Medicaid policy. As of March 11, 2021, North Carolina will be covering all approved COVID-19 vaccines for the following limited benefit eligibility groups: COVID-19 testing limited benefit group, Family Planning, and women who qualify due to pregnancy. Vaccine providers may bill Medicaid if it is determined that the beneficiary is in one of these limited eligibility groups.
In addition, internal NC Medicaid review of recently denied COVID-19 vaccine administration claims has led to modification of edits to allow many of these claims to process for payment. All providers are encouraged to resubmit previously denied claims for COVID-19 vaccine for possible payment. All rules for payment of the administration of COVID-19 vaccine continue to apply. The date of service will be used to determine payment amount.
Claims are now reimbursable even if originally denied for the following reasons:
- Vaccine CPT code and vaccine administration code were not both listed on the claim
- Charges were not added to the vaccine administration code
- Beneficiary received only Family Planning waiver benefits (as of DOS March 11, 2021)
- Second dose of vaccine was billed before the first dose
- Claims are reimbursable for the following scenarios:
- All eligible providers’ taxonomies will be reimbursed for vaccine administration
- All approved places of service will be eligible for payment
Please note claims may still not pay if the beneficiary has another insurance on file, provider is not enrolled in NC Medicaid, or the ordering provider is not listed on the claim.
NCTracks Contact Center: 800-688-6696