Medicaid Bulletin
Medicaid Bulletin Monthly Digest
Articles beginning January 2018 are available in the blog format.
Effective with date of service Jan. 30, 2018, the North Carolina Medicaid and NC Health Choice (NCHC) programs cover Coagulation Factor IX (Recombinant), GlycoPEGylated, lyophilized powder for solution for intravenous injection (Rebinyn) for use in the Physician’s Drug Program (PDP) when billed with HCPCS code J7199 - Hemophilia clotting factor, not otherwise classified.
The NC Division of Medical Assistance (DMA) has received calls concerning claim denials for some services provided by nurse practitioners (NPs) and physician assistants (PAs).
In accordance with 10A NCAC 22J .0106, a provider may refuse to accept a patient as a Medicaid patient and bill the patient as a private pay patient only if the provider informs the patient that the provider will not bill Medicaid for any services, but will charge the patient for all services provided.
NC Division of Medical Assistance (DMA) implemented a prior approval (PA) process for the Community Alternatives Program for Children and Disabled Adults (CAP/C and CAP/DA) home- and community-based services waivers for Level of Care (LOC) and CAP waiver services.
Changes to two clinical coverage policies – 2A-1, Acute Inpatient Hospital Services and 1A-4, Cochlear and Auditory Brainstem Implants – will soon become effective.
April is the last month to submit an attestation for the NC Medicaid Electronic Health Record Incentive Program for Program Year 2017. North Carolina’s Medicaid EHR Incentive Payment System will close for Program Year 2017 at midnight on April 30, 2018.
Every year, in accordance with 2 CFR part 200, subpart F, the NC Office of the State Auditor selects a sample of North Carolina Medicaid and NC Health Choice claims to review to determine the state’s compliance with federal and state regulations for claims paid in the prior state fiscal year, which runs from July 1 to June 30.
On April 29, 2018, a new reimbursement methodology will be implemented for medical claims for physician-administered Long Acting Reversible Contraceptives and vaccines, effective for claims with date of service July 1, 2017 and after.
Registration is open for the April 2018 instructor-led provider training course and annual seminar listed below. Slots are limited.
Per Session Law (S.L.) 2015-241, as of June 1, 2018, hospitals, mid-level physicians and nurse practitioners who currently have an electronic health record system must be connected to NC HealthConnex to continue to receive payments for North Carolina Medicaid and NC Health Choice services.