Medicaid Bulletin

Medicaid Bulletin Monthly Digest

Medicaid Bulletin Archive

Articles beginning January 2018 are available in the blog format.

Prepaid Health Plan Interest and Penalties for Provider Claims
Prepaid health plans are required to pay interest and penalties to providers if they fail to accurately pay or inappropriately deny a claim.
NC Medicaid Managed Care Provider Update – Sept. 15, 2021
Topics include key dates, playbook updates, prior authorization, FAQs, contracting, ombudsman, webinars and more.
Private Duty Nursing Clinical Coverage Policy 3G-1 for Beneficiaries Age 21 and Older
Oct 1, 2021 Update: The policy is amended with the effective date of Sept. 1, 2021.
Prior Approval Requirements Resume for Children’s Developmental Services Agency Providers
Effective Oct. 15, 2021, CDSAs and independent practitioners providing individualized family service plan services must resume submitting PA requests.
ICD-10 Annual Update Reminder
The 2022 ICD-10 update is effective Oct. 1, 2021
Anifrolumab-fnia Injection, for Intravenous Use (Saphnelo™) HCPCS Code J3590: Billing Guidelines
Effective Aug. 18, 2021, the Medicaid and NC Health Choice programs cover anifrolumab-fnia injection
North Carolina Standard & Tailored Plan Tobacco-Free Policy Requirement
Tobacco-related policy requirements go into effect on July 1, 2022.
NC Medicaid EHR Incentive Program Announcements - September, 2021
Two Months Left to Submit Program Year 2021 Attestations; Security Risk Analysis
Interim Process for Submitting Prior Authorization Requests for Beneficiaries Disenrolled to NC Medicaid Direct
Providers are encouraged to confirm which PA types are included in this long-term design.
Clinical Coverage Policy 11A-17 CAR T-Cell Therapy Revision Effective Oct. 1, 2021
Will cover all U.S. FDA approved CAR T-Cell Therapies when administered per U.S. FDA approved guidelines