Medicaid Bulletin
Billing Code Update for Nurse Practitioners and Physician Assistants
NC Medicaid has received calls concerning claim denials for some services provided by nurse practitioners (NPs) and physician assistants (PAs). NC Medicaid has provided instructions to NCTracks to update the claims processing system. The following procedure code list was recently updated to include additional NP and PA taxonomies.
Clinical Coverage Policies
The following new or amended clinical coverage policies are available on the NC Medicaid Clinical Coverage Policies web page.
Federal Enrollment Application Fee Increase for Year 2020
Section 6401(a) of the Affordable Care Act requires the Secretary to impose a fee on each "institutional provider of medical or other items or services and suppliers." Based upon provisions of the ACA, this fee will vary from year to year based on adjustments made pursuant to the Consumer Price Index for Urban Areas.
Whole-Person Care Survey
In an attempt to gain clarity around what whole-person care looks like across the state, the Foundation for Health Leadership and Innovation’s Center of Excellence for Integrated Care, in partnership with UNC-Chapel Hill School of Nursing, is conducting a short survey for primary care providers and behavioral/mental health professionals working in primary care.
NC Medicaid Electronic Health Record (EHR) Incentive Program Announcements
NC-MIPS is Open for Program Year 2019, Reminder from CMS Regarding Objective 6 and Objective 7, Clarification from CMS Regarding Objective 5 Measure 1: Patient Electronic Access and general reminders.
Clinical Coverage Policy Update
The following new or amended clinical coverage policies are available on the NC Medicaid Clinical Coverage Policies web page.
CPT Code Update: 2020
Effective with date of service Jan. 1, 2020, the American Medical Association (AMA) added new CPT codes, deleted others and changed the descriptions of some existing codes.
Commercial Insurance Disallowance
North Carolina Medicaid’s third-party liability (TPL) contractor, Health Management System, Inc. (HMS), will implement the Commercial Insurance (CI) disallowance project to streamline North Carolina’s coordination of benefits direct billing processes. The expected implementation date is Jan.
Rituximab-abbs injection, for intravenous use (Truxima®) HCPCS code Q5115: Billing Guidelines
Effective with date of service Nov. 11, 2019, the North Carolina Medicaid and NC Health Choice programs cover rituximab-abbs injection, for intravenous use (Truxima) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code Q5115 - Injection, rituximab-abbs, biosimilar, (Truxima), 10 mg.
Trastuzumab-dkst for injection, for intravenous use (Ogivri™) HCPCS code Q5114: Billing Guidelines
Effective with date of service Nov. 7, 2019, the North Carolina Medicaid and NC Health Choice programs cover trastuzumab-dkst for injection, for intravenous use (Ogivri) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code Q5114 - Injection, Trastuzumab-dkst, biosimilar, (Ogivri), 10 mg.
Medicaid Bulletin Monthly Digest
Articles beginning January 2018 are available in the blog format.
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