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.
Medicaid Bulletin
Articles published prior to January 2018 are available in the Medicaid Bulletin Archive.
Pegfilgrastim-bmez Injection, for Subcutaneous Use (Ziextenzo™) HCPCS Code J3590: Billing Guidelines
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.
Immune Globulin Intravenous, Human – Slra 10% Liquid (Asceniv™) HCPCS Code J1599: Billing Guidelines
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.
Effective with date of service Nov. 20, 2019, the NC Medicaid and NC Health Choice programs cover crizanlizumab-tmca injection, for intravenous use (Adakveo) for use in the Physician Administered Drug Program (when billed with HCPCS code J3590 - Unclassified biologics.
Effective with date of service Nov. 26, 2019, the NC Medicaid and NC Health Choice programs cover givosiran injection, for subcutaneous use (Givlaari) for use in the Physician Administered Drug Program when billed with HCPCS code J3490 - Unclassified drugs.
NC Medicaid has received calls concerning claim denials for some services provided by nurse practitioners and physician assistants. NC Medicaid has provided instructions to NCTracks to update the claims processing system. The following procedure code list was recently updated to include additional NP and PA taxonomies.
On Dec. 11, 2019, DHHS released for comments the draft provider manual and application process for care management for people with Behavioral Health and Intellectual and Developmental Disabilities (I/DDs) who will be served by Tailored Plans. The Department is revising the draft manual and will be issuing an updated version shortly.
The Foundation for Health Leadership and Innovation's Center of Excellence for Integrated Care, in partnership with UNC-Chapel Hill School of Nursing, is conducting a short survey.
NC-MIPS is Open for Program Year 2019, Reminder from CMS Regarding Objective 6 and Objective 7, Clarification from CMS Regarding Objective 5 Measure 1: Patient Electronic Access and general reminders.