Medicaid Bulletin

Effective April 1, 2018, when performing a wet mount screening, providers serving Family Planning Medicaid (MAFDN) beneficiaries shall bill procedure code 87210 (smear, primary source with interpretation; wet mount for infectious agents [e.g., saline, India ink, KOH preps]).

Facility providers can now access Sterilization Consent Form status, including denial reasons, on the secure NCTracks Provider Portal.

At various times of the year, Medicaid providers may receive notification of participation letters from the DMA Office of Compliance and Program Integrity which facilitates audits from various auditing agencies, e.g. Office of the Inspector General, Office of Internal Auditor, and Office of State Auditor.

Effective May 1, 2017, new pharmacy point of sale clinical edits for behavioral health medications were applied for pediatric and adult beneficiaries.

Registration is open for the February 2018 instructor-led provider training courses listed below. Slots are limited.

Effective Jan. 15, 2018, updates to Clinical Coverage Policy 3D, Hospice Services, are approved. The amended policy is posted to the North Carolina Medicaid website.

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

If a provider’s enrollment application or Manage Change Request (MCR) is clean and does not contain errors, it will process more quickly. The NCTracks Enrollment Team identified commons errors that cause delays in processing applications and MCRs.

Effective with the date of service of April 30, 2018, the North Carolina Medicaid and N.C. Health Choice programs will be terminating Clinical Policy 1B-2, Rituximab (Rituxan), within the Physician Drug Program.

Effective with the date of service of April 31, 2018, the North Carolina Medicaid and N.C. Health Choice programs will be terminating Clinical Policy 1B-1, Botulinum Toxin Treatment, within the Physician Drug Program.