Medicaid Bulletin

NC Medicaid has received calls concerning claim denials for some services provided by nurse practitioners and physician assistants. 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.

On Dec. 11, 2019, DHHS released for comments the draft provider manual and application process for care management for people with Behavioral Health and Intellectual and Developmental Disabilities (I/DDs) who will be served by Tailored Plans. The Department is revising the draft manual and will be issuing an updated version shortly.

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.

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.
 

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.

The following new or amended clinical coverage policies are available on the NC Medicaid Clinical Coverage Policies web page.

The following new or amended clinical coverage policies are available on the NC Medicaid Clinical Coverage Policies web page. 

NC Medicaid has updated its ICD-10 diagnosis code list.

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.

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.