Medicaid Bulletin

To ensure the waiver enrollment administrative processes are executed as approved in each waiver application, until the award of a contract to an external CIAE vendor, NC Medicaid will implement an internal independent assessment review process. This internal independent assessment process will begin in October 2020 with a go-live date of Oct. 19, 2020.   

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

CMS and the American Medical Association have released a CPT code for an antigen test designed to detect proteins from the virus that causes COVID-19 in respiratory specimens. NC Medicaid is adding this CPT code to NCTracks for medically necessary laboratory testing effective Sept. 1, 2020.

Guidelines for Evidenced-Based Synagis® Prophylaxis, Prior Approval Requests, Dose Authorization, Pharmacy Distributor Information, Provider Information, Submitting a Request to Exceed Policy and Technical Support.

Effective Sept. 1, 2020, the North Carolina Medicaid and NC Health Choice Programs will cover Oncotype Dx and EndoPredict genomic tests used for breast cancer treatment as part of Clinical Coverage policy 1S-7, Gene Expression Profiling for Breast Cancer.

NC Medicaid is temporarily increasing financial assistance to Federally Quality Health Centers (FQHCs) and Rural Health Centers (RHCs) to maintain critical access to care for Medicaid beneficiaries during the COVID-19 public health emergency. 

Medicaid/CHIP providers who have not yet submitted their applications for federal Provider Relief Fund are encouraged to apply. The deadline is Sunday, Sept. 13, 2020.

This bulletin outlines the process by which nursing homes may access interim payments of State-administered federal funding to support compliance with Secretarial Order No.2.

NC-MIPS is Open for Program Year 2020, Program Year 2020 Webinar Series and The Security Risk Analysis (SRA)
 

NC Medicaid is reimbursing COVID-19 testing costs for individuals without insurance who enroll in the NC Medicaid Optional COVID-19 Testing (MCV) program.