Medicaid Bulletin

NC-MIPS is Open for Program Year 2019, The Security Risk Analysis, Reminder from CMS Regarding Objective 6 and Objective 7, Clarification from CMS Regarding Objective 5 Measure 1: Patient Electronic Access and General Reminders

This communication serves as an advisory notice for all providers. The intent is to increase awareness of history-only adjustments and voids within NCTracks. 

The following new or amended clinical coverage policies are available on the Clinical Coverage Policies web page on NC Medicaid’s website.

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.