A fully detailed outline of the influenza vaccine and reimbursement guidelines for 2019-2020 for North Carolina Medicaid and NC Health Choice was distributed in a Medicaid Special Bulletin on Aug. 27, 2019.
Medicaid Bulletin
Medicaid Bulletin Monthly Digest
Articles beginning January 2018 are available in the blog format.
Effective with date of service Aug. 1, 2019, the North Carolina Medicaid and NC Health Choice programs cover infliximab-abda for injection, for intravenous use (Renflexis) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code Q5104 - Injection, infliximab-abda, biosimilar, (renflexis), 10 mg.
The Department of Health and Human Services (DHHS) recently launched an online “Provider Playbook” as part of its commitment to ensure providers have resources to help Medicaid beneficiaries transition smoothly to Medicaid Managed Care. This new Provider Playbook is a collection of information and tools specifically tailored to providers.
Effective with date of service June 20, 2019, the North Carolina Medicaid and NC Health Choice programs cover dexamethasone ophthalmic insert 0.4 mg, for intracanalicular use (Dextenza) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J3490 - Unclassified drugs.
Several new or amended clinical coverage policies are available on NC Medicaid’s website.
NC Medicaid has received calls concerning claim denials for some services provided by nurse practitioners (NPs) and physician assistants (PAs). NC Medicaid has provided instructions to NCTracks on updating the claims processing system.
The NC Medicaid EHR Incentive Payment System (NC-MIPS) is only accepting Program Year 2019 Stage 3 Meaningful Use (MU) attestations.
The sterilization consent form found on the U.S. Department of Health & Human Services (HHS) website has been updated.
Effective July 28, 2019, the presumptive eligibility provider enrollment process will be transitioned from NC Medicaid to NCTracks. NCTracks will assume the enrollment process for providers of presumptive eligibility for pregnant women and hospital providers of presumptive eligibility for Medicaid programs.
Effective July 1, 2019, providers may request, perform and bill for low-dose lung cancer screening utilizing healthcare common procedure coding system (HCPCS) code G0297.