Medicaid Bulletin
Protocol for Changing Advanced Medical Home Tier Status
As NC Medicaid’s managed care launch date approaches, Advanced Medical Home (AMH) providers who believe they are not ready to meet program requirements to perform at the tier level to which they attested may now submit a request to change their AMH Tier status from Tier 3 to Tier 2. The AMH Tier 3 providers may not downgrade lower than AMH Tier 2.
HCPCS CODE A4252: Blood Ketone Test or Reagent Strip
Per Clinical Coverage Policy 5A-3, Nursing Equipment and Supplies on the NC Medicaid website, HCPCS code A4252 (blood ketone test or reagent strip, each) has a quantity limitation of 100 test strips per month. Considering the national description of A4252 refers to each test strip, DME providers are reminded to submit their claims with the number of test strips supplied to the beneficiary, not the number of boxes of test strips.
SPECIAL BULLETIN: Carolina Complete Health Awarded Additional Region in Medicaid Managed Care
The North Carolina Department of Health and Human Services (DHHS) has expanded the regions awarded to Carolina Complete Health, Inc. (CCH) to serve as a health plan under the state’s transition to Medicaid Managed Care. In addition to serving regions 3 and 5 in the state, the provider-led health plan will also serve region 4.
Billing Code Update
NC Medicaid has received calls concerning claim denials for some services provided by nurse practitioners (NPs) and physician assistants (PAs).
Sterilization Consent Form
Providers were notified in the August Medicaid bulletin that as of May 1, 2019, the sterilization consent form was updated with an expiration date of April 30, 2022. The sterilization consent form found on the U.S. Department of Health & Human Services (HHS) website has been updated. Providers should now be using this version when submitting the sterilization consent form to the NC Medicaid fiscal agent.
Billing for Nexplanon Implants - Long Acting Reversible Contraceptives (LARCs)
Effective Oct. 1, 2019, two additional ICD-10 codes will be added to the LARC DRG reimbursement retroactive date of Oct. 1, 2018.
Providers must bill with the following HCPCS code, and the appropriate ICD-10 PCS code on the inpatient hospital claim to receive the LARC DRG reimbursement.
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).
Updates to Clinical Coverage Policy 5A-3, Nursing Equipment and Supplies
On Oct. 1, 2019, an amended version of Clinical Coverage Policy 5A-3, Nursing Equipment and Supplies, was posted to the North Carolina Medicaid website. In addition to correcting numbering, grammatical and style errors, several changes have been made.
ICD-10 Update for 2020
The 2020 ICD-10 update will be in place effective Oct. 1, 2019 through Sept. 30, 2020, for provider use. Providers can access the list of ICD-10 codes on the Centers for Medicare and Medicaid Services (CMS) website.
Procedures for Prior Authorization of Synagis® (palivizumab) for Respiratory Syncytial Virus Season 2019-2020
The clinical criteria used by NC Medicaid for the 2019-2020 Respiratory Syncytial Virus (RSV) season are consistent with guidance published by the American Academy of Pediatrics (AAP): 2018 – 2021 Report of the Committee on Infectious Diseases, 31st Edition. This guidance for Synagis use among infants and children at increased risk of hospitalization for RSV infection is available online by subscription. The coverage season is Nov. 1, 2019, through March 31, 2020. Providers are encouraged to review the AAP guidance prior to the start of the RSV season.
Medicaid Bulletin Monthly Digest
Medicaid Bulletin Archive (Prior to January 2018)
Articles beginning January 2018 are available in the blog format below.
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