Medicaid Bulletin
The Affiliation Edit: What It Is and How to Prevent It
This edit is in place to ensure billing providers are affiliated with the rendering (individual) providers for whom they are billing to prevent inaccurate payment or fraud.
Cemiplimab-rwlc Injection, for Intravenous Use (Libtayo®) HCPCS Code J9999: Billing Guidelines
Effective with date of service Oct. 8, 2018, North Carolina Medicaid and NC Health Choice programs cover cemiplimab-rwlc injection, for intravenous use (Libtayo) for use in the Physician Administered Drug Program when billed with HCPCS code J9999 - Not Otherwise Classified, Antineoplastic Drugs.
Errors on Provider Records in NCTracks
Enrollment applications submitted with incorrect data including name, Social Security number (SSN) and date of birth (DOB) result in application denials and withdrawals. As a result, providers must submit new applications and pay any applicable fees. This delay can impact the fingerprint processing and may put providers at risk of suspension or termination for failure to complete the recredentialing/reverification process by the due date.
Proposed Clinical Coverage Policies for Public Comment
As of Dec. 1, 2018, there are no NC Medicaid policies posted for public comment.
Policy Clarification for Out-of-state Providers
Out-of-state providers, including border-area providers, must be enrolled in Medicare or their home-state Medicaid program to enroll in North Carolina Medicaid and NC Health Choice programs.
Money Follows the Person Project Update and Application Change
The Money Follows the Person Demonstration Project (MFP) team is preparing for the 2019-2023 Medicaid Transition Period and has updated its application for the coming year.
Summary of New or Amended Clinical Coverage Policies Posted Since Nov. 1, 2018
The following new or amended Medicaid and NC Health Choice clinical coverage policies were posted since Nov. 1, 2018. Visit the NC Medicaid website to view the policies.
Change In Scope of Services (CISS) Policy
In accordance with the North Carolina’s Medicaid State Plan, Federally Qualified Health Centers (FQHCs) and Rural Health Centers (RHCs) may request a “rate adjustment due to change in scope of services."
Telephonic Evaluation and Management is Again Being Offered for the 2018-2019 Influenza Season
In response to the anticipated higher than normal number of influenza cases this coming season, effective December 1, 2018, North Carolina Medicaid is offering telephonic evaluation and management services to beneficiaries who are actively experiencing flu-like symptoms.
Clinical Coverage Policy (CCP) 1-H, Telemedicine and Telepsychiatry
System changes have been completed to allow non-psychiatric Nurse Practitioners and Physician Assistants to receive reimbursement for the following CPT codes when provided via telemedicine/telepsychiatry:
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