Medicaid Bulletin

Per Session Law (S.L.) 2015-241, as amended by S.L. 2017-57, North Carolina providers who are reimbursed by the state for providing health care services under N.C. Medicaid and N.C. Health Choice programs must join NC HealthConnex, the state-designated Health Information Exchange.

The N.C. Medicaid and N.C. Health Choice (NCHC) application fee is $100, which covers costs associated with processing enrollment applications.

Effective Oct. 29, 2017, NCTracks will implement a quarterly Maintain Eligibility Process which identifies providers with no claim activity within the past 12 months. The provider must attest electronically in NCTracks to remain active.

Clinical Coverage Policy (CCP) 11B-4, Kidney (Renal) Transplantation, has been revised.

The American Medical Association (AMA) publishes an annual Current Procedural Terminology (CPT) manual each fall outlining new, revised, and deleted procedural codes effective January 1 of the following calendar year.

The following new or amended combined N.C. Medicaid and N.C. Health Choice clinical coverage policies are available on DMA’s clinical coverage policy web pages.

Note: This article was previously published in the September 2017 Medicaid Bulletin. It is being republished with updates.

The Centers for Medicare & Medicaid Services announced an increase in the Affordable Care Act provider enrollment application fee.

Effective with date of service Oct. 15, 2017, the NC Medicaid Program covers triamcinolone acetonide extended-release injectable suspension, for intra-articular use (Zilretta) for use in the Physician’s Drug Program (PDP) when billed with HCPCS code J3490 - Unclassified drugs.

Note: This article is being republished monthly. It was originally published in the December 2017 Medicaid Bulletin with revisions.