Medicaid Bulletin

Medicaid Bulletin Monthly Digest

Bulletins published prior to January 2019

Articles since January 2018 are available in the blog format below.

Preadmission Screening Resident Review (PASRR) Program Update

Monday, April 1, 2019

Effective Dec. 1, 2018, the North Carolina Medicaid Uniform Screening Tool (NCMUST) application and operation of the Level 1 PASRR screen process transitioned from a NC Medicaid vendor to NC DHHS ITD and NC Medicaid.  The transition enables NC DHHS to achieve a more efficient screening process for PASRRs and provide NCDHHS with direct knowledge of issues and barriers that may impact the timely processing of PASRR Level 1 screens and Level 2 evaluations. 

Pegfilgrastim-cbqv injection, for subcutaneous use (Udenyca™) HCPCS code Q5111: Billing Guidelines

Monday, April 1, 2019

Effective with date of service Jan. 3, 2019, the North Carolina Medicaid and NC Health Choice programs cover pegfilgrastim-cbqv injection, for subcutaneous use (Udenyca) for use in the Physician Administered Drug Program when billed with HCPCS code Q5111 - Injection, pegfilgrastim-cbqv, biosimilar, (Udenyca), 0.5 mg.

Updates to the NC Medicaid Electronic Health Record (EHR) Incentive Program

Monday, April 1, 2019

April is the last month to submit an attestation for Program Year 2018. The NC Medicaid EHR Incentive Payment System (NC-MIPS) will close for Program Year 2018 at midnight on Apr. 30, 2019. After that no changes can be made. Eligible professionals (EP) are strongly advised to review their attestation and documentation for accuracy and completeness

Regional Provider Training

Monday, April 1, 2019

Personal Care Services (PCS) regional training sessions will be held May 13-22, 2019.  Registration begins at 8 a.m. and training will be held from 9 a.m. to 1:30 p.m. Training sessions are free, but registration is required.

Fluocinolone acetonide intravitreal implant (Yutiq™) HCPCS code J7313 Injection, fluocinolone acetonide, intravitreal implant, 0.01 mg: Billing Guidelines

Monday, April 1, 2019

Effective with date of service of Feb. 4, 2019, the North Carolina Medicaid and NC Health Choice programs cover fluocinolone acetonide intravitreal implant (Yutiq) for use in the Physician Administered Drug Program when billed with HCPCS code J7313 Injection, fluocinolone acetonide, intravitreal implant, 0.01 mg.

New Platform for NC HealthConnex to Launch in April

Monday, April 1, 2019

Beginning in April, participating health care providers in the state-designated health information exchange (HIE), NC HealthConnex, will be moving to a new HIE platform.

Centralized Provider Credentialing

Monday, April 1, 2019

The Department recognizes that the move to managed care may impose additional administrative burdens and program complexity to the work NC providers already do. To mitigate the administrative burden on providers as NC Medicaid transitions to managed care, the Department procured a contractor to supplement the state’s existing provider enrollment data. This data will be combined with provider enrollment information NC Medicaid has on file to support the Prepaid Health Plans’ (PHPs’) ability to help determine which providers to contract with.

NC Medicaid-3136 and 3085 Form Submission

Monday, April 1, 2019

Effective Mar. 4, 2019, NC Medicaid implemented functionality in QiRePort allowing providers to submit the Internal Quality Improvement Program Attestation (NC Medicaid-3136) and Session Law 2013-306 PCS Training Attestation (NC Medicaid-3085) Forms via upload.

Omadacycline for Injection, for Intravenous Use (Nuzyra™) HCPCS code J3490 - Unclassified drugs: Billing Guidelines

Monday, April 1, 2019

Nuzyra is available as 100 mg of omadacycline (equivalent to 131 mg omadacycline tosylate) as a lyophilized powder in a single dose vial for reconstitution and further dilution before intravenous infusion.

Remittance Statement of Adjustment for Third Party Recovery

Monday, April 1, 2019

The State and GDIT are in the process of completing NCTracks system updates to provide notification on the Remittance Statement of adjustment actions taken on previously paid claims due to audits conducted by Third Party Recovery and the Office of Compliance and Program Integrity.

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