Medicaid Bulletin

Medicaid Bulletin Monthly Digest

Medicaid Bulletin Archive

Articles beginning January 2018 are available in the blog format.

Famotidine Injection (Pepcid®) HCPCS Code J3490: Billing Guidelines

Effective with date of service Jan. 1, 2020, the Medicaid and NC Health Choice programs cover famotidine injection (Pepcid®) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J3490 - Unclassified drugs.

Clinical Policy 1E-3, Sterilization Procedures – Claim Denials

Claim Denials for Sterilization CPT Code 58661

Clinical Policy 1E-3, Sterilization Procedures - Sterilization Consent Form

Updates on the consent form expiration date and clarifications related to the Aug. 15, 2020 policy update.

Amisulpride Injection, for Intravenous Use (Barhemsys®) HCPCS Code J3490: Billing Guidelines

Effective with date of service Aug. 4, 2020, the Medicaid and NC Health Choice programs cover amisulpride injection, for intravenous use (Barhemsys®) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J3490 - Unclassified drugs.

Application Period Open for Tailored Care Management Certification
The Tailored Care Management certification process is now open, and providers may submit applications.
Provider Selection of Electronic Visit Verification Vendor Required for Jan. 1, 2021 Implementation

Providers subject to EVV are required to utilize an electronic verification system to capture in-home visits to align with the state and federal guidelines. The enrollment or selection of an EVV vendor must be made by Dec. 18, 2020, to ensure NC Medicaid meets the Jan. 1, 2021 deadline for implementation.

Electronic Visit Verification Billing and LME-MCO Update

NC Medicaid’s Electronic Visit Verification (EVV) system will launch on Jan. 1, 2021, for State Plan Personal Care Services, CAP/DA and CAP/C. During the first 90 days following launch, we will operate EVV as “Pay and Report.” EVV implementation for TBI waiver and LME-MCO services programs is planned for April 2, 2021.

Upcoming Provider Webinars

Provider webinars in December include Advanced Medical Home on December 10, COVID-19 Vaccine Distribution on December 15, and Behavioral Health on December 17.

Medicaid Managed Care Provider Update

Key dates for transitioning to Medicaid Managed Care, contracting reminders, webinar series for providers and practice leaders, review your provider records in NCTracks, the Provider Ombudsman, PHP manuals updated and the beneficiary portal. 

Required Electronic Visit Verification Survey Deadline Extended

NC Medicaid State Plan Personal Care Services (PCS) and Community Alternatives Programs (CAP) providers who render personal care-type services, are required to complete a secure survey regarding Electronic Visit Verification (EVV) by Dec. 7, 2020.