Medicaid Bulletin

The following new or amended combined North Carolina Medicaid and NC Health Choice clinical coverage policies are available on Medicaid’s Clinical Coverage Policy web pages.

The procedure code list for nurse practitioners (NPs) and physician assistants (PAs) has been updated recently to include additional NP and PA taxonomies.

Effective July 1, 2018, North Carolina Medicaid and NC Health Choice behavioral health providers who were added to NCTracks via the Local Management Entity/Managed Care Organization Provider Upload process must complete reverification. Providers identified are being notified of their reverification due date via NCTracks communication to the Office Administrator on record.

This announcement is to inform Community Alternatives Program for Children providers of revisions to the technical changes in Clinical Coverage Policy, 3K-1, Community Alternatives Program for Children (CAP/C). 

In response to provider comments and questions regarding billing under the new federal Ordering, Prescribing and Referring (OPR) rules, North Carolina Medicaid is issuing this clarification for radiology and Independent Diagnostic Testing Facilities (IDTF).

In response to the higher than normal number of influenza cases and influenza-related complications and deaths, North Carolina Medicaid is offering telephonic evaluation and management services to beneficiaries who are actively experiencing flu-like symptoms.

The use of the NPI Exemption List for residents and interns enrolled in graduate dental and medical programs, and area health education centers will cease on Jan. 31, 2018. Clinical Pharmacist Practitioners will continue to use the NPI Exemption List until further notice.

In response to provider feedback, the use of the NPI Exemption List for residents and interns enrolled in graduate dental and medical programs, and area health education centers will be extended from January 31, 2018 to April 30, 2018. 

Effective May 1, 2017, new pharmacy point of sale clinical edits for behavioral health medications were applied for pediatric and adult beneficiaries. Note: This article was originally published in February 2017 Medicaid Bulletin.

In response to provider comments and questions regarding the December 2017 Special Bulletin, Billing Guidance:340B Modifiers, North Carolina Medicaid is publishing updated information regarding the use of the JG, TB and UD modifiers which are required to identify 340B drug claims.