Medicaid Bulletin
Clinical Coverage Policies
The following new or amended Medicaid and NC Health Choice clinical coverage policies were posted since Aug. 31, 2018.
Plazomicin Injection, for Intravenous Use (Zemdri™) HCPCS Code J3490: Billing Guidelines
Effective with date of service Aug. 17, 2018, the Medicaid and NC Health Choice programs cover plazomicin injection, for intravenous use (Zemdri) for use in the Physician's Drug Program when billed with HCPCS code J3490-Unclassified drugs.
Avoid Delays in the Processing of Applications for Providers Enrolling as Individuals
If a provider’s enrollment application or Manage Change Request (MCR) does not contain errors, it will process more quickly. NC Medicaid and the NCTracks Enrollment Team frequently share information about commons errors that cause delays in processing applications and MCRs.
Are You in Compliance with North Carolina Law?
North Carolina health care providers are required by law to connect with NC HealthConnex, North Carolina’s designated health information exchange.
Update to Reimbursement of Long Acting Reversible Contraceptives (LARCs)
Effective for dates of service on or after Oct. 1, 2018, the following DRG classifications specific to LARCs will be added to the current Grouper 36 version within NCTracks for claims reimbursement.
ICD-10 Update for 2019
The 2019 ICD-10 update is effective Oct. 1, 2018 through Sept. 30, 2019, for provider use.
Updates to the NC Medicaid Electronic Health Record (EHR) Incentive Program
Per the updated IPPS Final Rule released Aug. 2, 2018, the EHR reporting period will now be referred to as the Promoting Interoperability (PI) reporting period.
Pre-Admission Screening and Resident Review (PASRR) Program Update
The Department of Health and Human Services is implementing the Referral Screening Verification Process (RSVP) for individuals being considered for admission to an Adult Care Home (ACH) effective Nov. 1, 2018.
Balloon Ostial Dilation (BOD) Services Billed with Modifier 50 (Bilateral)
Claims for balloon sinus ostial dilation billed with modifier 50 (bilateral) have been resulting in an underpayment to providers. The issue has been resolved. Providers with claims for the following procedures billed with modifier 50 on or after July 29, 2018, should resubmit their claims for reprocessing.
NCTracks Provider Training Available in October 2018
Registration is open for several instructor-led training courses for providers that will be held in October 2018.
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