Medicaid Bulletin

The North Carolina Division of Health Benefits (DHB) would like to reiterate the 340B provider and claim submission requirements for both the outpatient pharmacy and Physician’s Drug Program (PDP). 

Effective with date of service June 11, 2019, the North Carolina Medicaid and NC Health Choice programs cover polatuzumab vedotin-piiq for injection, for intravenous use (Polivy) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J9999 - Not otherwise classified, antineoplastic drugs.

Supporting beneficiaries in their transition between the current fee-for-service delivery system and NC Medicaid Managed Care is called transition of care. The transitional period surrounding the launch of Medicaid Managed  Care is referenced as crossover.

A fully detailed outline of the influenza vaccine and reimbursement guidelines for 2019-2020 for North Carolina Medicaid and NC Health Choice was distributed in a Medicaid Special Bulletin on Aug. 27, 2019.

Effective with date of service Aug. 1, 2019, the North Carolina Medicaid and NC Health Choice programs cover infliximab-abda for injection, for intravenous use (Renflexis) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code Q5104 - Injection, infliximab-abda, biosimilar, (renflexis), 10 mg.

The Department of Health and Human Services (DHHS) recently launched an online “Provider Playbook” as part of its commitment to ensure providers have resources to help Medicaid beneficiaries transition smoothly to Medicaid Managed Care. This new Provider Playbook is a collection of information and tools specifically tailored to providers.

Effective with date of service June 20, 2019, the North Carolina Medicaid and NC Health Choice programs cover dexamethasone ophthalmic insert 0.4 mg, for intracanalicular use (Dextenza) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J3490 - Unclassified drugs.

Several new or amended clinical coverage policies are available on NC Medicaid’s website.

NC Medicaid has received calls concerning claim denials for some services provided by nurse practitioners (NPs) and physician assistants (PAs). NC Medicaid has provided instructions to NCTracks on updating the claims processing system.

The NC Medicaid EHR Incentive Payment System (NC-MIPS) is only accepting Program Year 2019 Stage 3 Meaningful Use (MU) attestations.