Medicaid Bulletin

To ensure that the Department gives providers enough time to prepare their applications after the release of the finalized manual, the Department has decided to further extend the initial application deadline for providers from Feb. 21, 2020, to June 2020.

On Jan. 31 ,2020, the North Carolina Department of Health and Human Services announced that Keystone Peer Review Organization, Inc. received the contract as the Comprehensive Independent Assessment Entity. 

We are pleased to share for comment the Behavioral Health I/DD Tailored Plan Request for Applications (RFA) Pre-Release Policy Paper. This complements prior policy papers issued by the Department between 2017 and early 2020 and is intended to give stakeholders additional insight into Behavioral Health I/DD Tailored Plan design areas not previously addressed in other policy papers. 

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

Effective with date of service Nov. 8, 2019, the NC Medicaid and NC Health Choice programs cover pegfilgrastim-bmez injection, for subcutaneous use (Ziextenzo) for use in the Physician Administered Drug Program when billed with HCPCS code J3590 - Unclassified biologics.

Effective with date of service Nov. 11, 2019, the NC Medicaid and NC Health Choice programs cover luspatercept-aamt for injection, for subcutaneous use (Reblozyl) for use in the Physician Administered Drug Program when billed with HCPCS code J3590 - Unclassified biologics.

Effective with date of service Nov. 18, 2019, the NC Medicaid and NC Health Choice programs cover immune globulin intravenous, human – slra 10% liquid (Asceniv) for use in the Physician Administered Drug Program when billed with HCPCS code J1599 - Injection, immune globulin, intravenous, non-lyophilized (e.g., liquid), not otherwise specified, 500 mg.

Effective with date of service Nov. 20, 2019, the NC Medicaid and NC Health Choice programs cover crizanlizumab-tmca injection, for intravenous use (Adakveo) for use in the Physician Administered Drug Program (when billed with HCPCS code J3590 - Unclassified biologics.

Effective with date of service Nov. 26, 2019, the NC Medicaid and NC Health Choice programs cover givosiran injection, for subcutaneous use (Givlaari) for use in the Physician Administered Drug Program when billed with HCPCS code J3490 - Unclassified drugs.

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.