Medicaid Bulletin

Key milestone dates, where to turn for help, Provider Playbook, PHP quick reference guides, webinars, Provider Directory, Help Center and Provider Ombudsman.

Effective for dates of service on or after July 1, 2021, prior approval for solid organ and stem cell transplants will no longer be required.

NC Medicaid is seeking input from people who work in HCBS, those who receive care and the public on how North Carolina can most effectively allocate the funds.

This Bulletin contains updates on the implementation of electronic visit verification (EVV) claims adjudication, entering manual visits, alternate EVV solutions, EVV system updates, EVV implementation for Innovations and TBI Waivers administered by LME-MCOs, EVV implementation for managed care health plans, and quick help tips and resources. 

Beginning May 9, 2021, NC Medicaid initiated additional steps to ensure providers meet their contractual obligation to keep credentials current on their NCTracks provider enrollment record.

Medicaid is adding codes into NCTracks to report negative pressure wound therapy utilizing disposable, non-durable medical equipment.

NCTracks continues sending notifications of suspension to providers through the Provider Message Center Inbox for failure to update expiring credentials. 

Effective for dates of service on or after July 1, 2021, prior approval for high tech imaging services will no longer be required for North Carolina Medicaid Direct beneficiaries.

NC Medicaid will sunset its CARES Act funded reimbursement of nursing facility staff COVID-19 testing in June 2021. This bulletin provides an update on processing timelines for previously submitted cases and provides additional guidance for final payments under this initiative.

Revisions have been made to Clinical Policy 1A-20, Sleep Studies and Polysomnography Services effective May 1, 2021.