Medicaid Bulletin

Medicaid Bulletin Monthly Digest

Medicaid Bulletin Archive

Articles beginning January 2018 are available in the blog format.

Procedures for Prior Authorization of Palivizumab (Synagis®) for Respiratory Syncytial Virus Season 2022/2023
Coverage season starts Oct. 1, 2022.
ICD-10 Annual Update Reminder
The 2023 ICD-10 update is effective Oct. 1, 2022, through Sept. 30, 2023, for provider use for dates of service within this period.
Provider Claims Payment Issues
Providers should contact the PHPs and Provider Ombudsman to resolve issues.
NC Medicaid Managed Care Provider Update – Sept. 16, 2022
Key milestones, playbook updates, verifying eligibility, provider reverification, provider records, behavioral health services transition and more
Updates to Clinical Coverage Policy 1A-5, Child Medical Evaluation and Medical Team Conference for Child Maltreatment Policy
Updates to Clinical Coverage Policy 1A-5 with an effective date of Sept. 2, 2022.
Electronic Visit Verification Home Health Services Taxonomy and Bill Type Information
Attention Standard Plans/Tailored Plans/HHA Exchange/CareBridge and Healthy Blue
Tailored Plan Eligibility and Enrollment Updates for Aug. 1, 2022, Auto-Enrollment
Updates on Tailored Plan criteria review, eligibility criteria, enrollment and health care options, and resources for Beneficiaries and Providers.
REMINDER: Healthy Opportunities Services Available
What services are available, in which regions, and how providers can refer patients.
Provider Requirements related to Billing Medicaid Beneficiaries
Providers shall not bill a NC Medicaid beneficiary for services furnished to a beneficiary who the provider has accepted as a Medicaid patient.
Prior Approvals for Out of State Services Changes
The adjudication of some prior approvals will be performed by GDIT Fiscal Agent Operations Reviewers instead of clinical reviewers at NC Medicaid