Medicaid Bulletin
E&M Code Reprocessing Notice
NC Medicaid will reprocess claims with dates of service between Jan. 1, 2019 and Sept. 3, 2019, paid to primary care physicians, nurse practitioners and physician assistants submitted with E&M codes ranging from 99201 to 99499 and the corresponding taxonomies as defined in Section 1202 of the Affordable Care Act (ACA).
Procedure for 340B Drug Claim Submissions
The North Carolina Division of Health Benefits (DHB) would like to reiterate the 340B provider and claim submission requirements for both the outpatient pharmacy and Physician’s Drug Program (PDP).
Revisions to Hematopoietic Stem Cell Transplantation Clinical Coverage Policies
Hematopoietic Stem Cell Transplantation (HSCT) clinical coverage policies have been revised. The revisions, which will become effective Oct. 1, 2019 are outlined below:
Updates to NC Medicaid Electronic Health Record (EHR) Incentive Program
The NC Medicaid EHR Incentive Payment System (NC-MIPS) is only accepting Program Year 2019 Stage 3 Meaningful Use (MU) attestations. All eligible professionals (EPs) attesting in Program Year 2019 will be required to attest to Stage 3 MU and use a 2015 Edition of certified EHR technology (CEHRT).
Dexamethasone ophthalmic insert 0.4 mg, for intracanalicular use (Dextenza®) HCPCS code J3490: Billing Guidelines
Effective with date of service June 20, 2019, the North Carolina Medicaid and NC Health Choice programs cover dexamethasone ophthalmic insert 0.4 mg, for intracanalicular use (Dextenza) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J3490 - Unclassified drugs.
Recent Changes to State Health Information Exchange, NC HealthConnex
North Carolina’s state-designated health information exchange, NC HealthConnex, was created in 2015 by the North Carolina General Assembly to help bridge the gap between distinct electronic health record systems and health care networks to support whole patient care. With over seven million unique patient records and growing, NC HealthConnex is working to connect the state’s health care providers to deliver a holistic view of a patient’s record.
Polatuzumab vedotin-piiq for Injection, for Intravenous Use (Polivy™) HCPCS code J9999: Billing Guidelines
Effective with date of service June 11, 2019, the North Carolina Medicaid and NC Health Choice programs cover polatuzumab vedotin-piiq for injection, for intravenous use (Polivy) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J9999 - Not otherwise classified, antineoplastic drugs.
Influenza Vaccine and Reimbursement Guidelines for 2019-2020 for North Carolina Medicaid and NC Health Choice
A fully detailed outline of the influenza vaccine and reimbursement guidelines for 2019-2020 for North Carolina Medicaid and NC Health Choice was distributed in a Medicaid Special Bulletin on Aug. 27, 2019.
DHHS Provider Resources for Transition to Medicaid Managed Care
The Department of Health and Human Services (DHHS) recently launched an online “Provider Playbook” as part of its commitment to ensure providers have resources to help Medicaid beneficiaries transition smoothly to Medicaid Managed Care. This new Provider Playbook is a collection of information and tools specifically tailored to providers.
Infliximab-abda for Injection, for Intravenous Use (Renflexis® ) HCPCS code Q5104: Billing Guidelines
Effective with date of service Aug. 1, 2019, the North Carolina Medicaid and NC Health Choice programs cover infliximab-abda for injection, for intravenous use (Renflexis) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code Q5104 - Injection, infliximab-abda, biosimilar, (renflexis), 10 mg.
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