Medicaid Bulletin

Effective May 1, 2018, Clinical Coverage Policy 1C-1, Podiatry Services, is revised to include annual updates to International Classification of Diseases (ICD-10-CM) codes.

42 CFR 455.450 requires a state Medicaid agency to screen all initial provider applications based on a categorical risk level of “limited,” “moderate,” or “high.” 

Registration is open for several instructor-led training courses for providers that will be held in May 2018. Slots are limited.

The NC Medicaid Electronic Health Record (EHR) Incentive Program is no longer accepting Program Year 2017 attestations.

Per Session Law (S.L.) 2015-241, as of June 1, 2018, hospitals, mid-level physicians and nurse practitioners who currently have an electronic health record system must be connected to NC HealthConnex to continue to receive payments for Medicaid and NCHC services.

The Department of Health and Human Services, Division of Medical Assistance, provides notice of its intent to amend the Medicaid State Plan to increase the rates for metabolic formula – Durable Medical Equipment.

By July 1, 2018, Medicaid behavioral health providers added to NCTracks by their current Local Management Entity/Managed Care Organization Provider Upload Process must complete re-verification.

Effective May 1, 2018, North Carolina Medicaid will cover digital breast tomosynthesis (3D tomosynthesis) for both screening and diagnostic mammography.

The following new or amended combined North Carolina Medicaid and NC Health Choice clinical coverage policies are available on Medicaid’s Clinical Coverage Policy web pages.

The implementation of ICD-10-CM allows specificity for accurate coding, resulting in greater justification of medical necessity. A provider’s documentation must include details to completely depict the nature of a beneficiary’s diagnosis and procedures performed.