Medicaid Bulletin

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

On Jan. 29, 2013, NC Medicaid issued a memorandum giving guidance on the subject of Guidance for Family Supplementing Payment to the Medicaid Benefit. Several adult care home (ACH) providers have recently referenced this memorandum when inquiring about payment supplements specifically related to the provision of Personal Care Services (PCS) to recipients of special assistance. 

Effective Oct. 1, 2019, two additional ICD-10 codes will be added to the LARC DRG reimbursement retroactive date of Oct. 1, 2018.  

Providers must bill with the following HCPCS code, and the appropriate ICD-10 PCS code on the inpatient hospital claim to receive the LARC DRG reimbursement.

NC Medicaid has received calls concerning claim denials for some services provided by nurse practitioners (NPs) and physician assistants (PAs).

Effective with date of service July 22, 2019, the North Carolina Medicaid and NC Health Choice programs cover bevacizumab-awwb injection, for intravenous use (Mvasi™) for adult use in the Physician Administered Drug Program when billed with HCPCS code Q5107 - Injection, bevacizumab, (Mvasi™), 10 mg.

Beginning Oct. 15, 2019, North Carolina Medicaid Bulletin articles will be delivered more often and in an online format. The improvements are in response to feedback from providers looking for a flexible way to receive important Medicaid information to better serve beneficiaries and more effectively operate their businesses.

*NOTE: THE CONTENT OF THIS BULLETIN IS AN UPDATE TO A MEDICAID SPECIAL BULLETIN PREVIOUSLY PUBLISHED ON SEPT. 5, 2019 REGARDING FLEXIBILITIES RELATED TO HURRICANE DORIAN.

This Special Bulletin includes several articles regarding Hurricane Dorian.

For inclusion in auto-enrollment, provider contracts must be signed and mailed to health plans no later than Nov. 15, 2019.

For inclusion in auto-enrollment, provider contracts must be signed and mailed to the health plans no later than Nov. 15, 2019. A list of questions and answers is provided for reference regarding this deadline.

NC Medicaid will reprocess claims with dates of service between Jan. 1, 2019 and Sept. 3, 2019, paid to primary care physicians, nurse practitioners and physician assistants submitted with E&M codes ranging from 99201 to 99499 and the corresponding taxonomies as defined in Section 1202 of the Affordable Care Act (ACA).