The following new or amended clinical coverage policies are available on NC Medicaid’s website. These policies supersede previously published policies and procedures.
Medicaid Bulletin
Medicaid Bulletin Monthly Digest
Articles beginning January 2018 are available in the blog format.
For clarification purposes of information communicated in October 2018 Medicaid Bulletin, please note that effective Oct.
A contract has been awarded to Wipro Infocrossing to serve as the Provider Data Contractor (PDC), as NC Medicaid transitions to Managed Care.
There are only four months left to submit an attestation for Program Year 2018. Attestations submitted after Feb. 28, 2019 are not guaranteed to be reviewed by program staff prior to close of Program Year 2018. Providers have until April 30, 2019 to submit a complete and accurate attestation for Program Year 2018. After that no changes can be made.
Clinical Policy 1E-7, Family Planning Services, has been revised effective Jan. 1, 2019.
Effective with date of service Nov. 19, 2018, the NC Medicaid and Health Choice programs cover risperidone for extended-release injectable suspension, for subcutaneous use (Perseris™) for use in the Physician Administered Drug Program when billed with HCPCS code J3490 - Unclassified drugs.
As a reminder, providers are to request and obtain proper prior authorization before services are scheduled or rendered. Contractually, GDIT has five business days (excluding holidays and weekends) to process a medical PA request once all required information is obtained. Pharmacy PAs are processed within 24 hours. Medical necessity cannot be determined with a partial or incomplete clinical picture.
Registration is open for the January 2019 instructor-led provider training courses listed below. Slots are limited. WebEx courses can be attended remotely from any location with a telephone, computer and internet connection. Please note that the WebEx information has changed.
Effective with date of service Oct. 22, 2018, the NC Medicaid and Health Choice programs cover moxetumomab pasudotox-tdfk for injection, for intravenous use (Lumoxiti™) for use in the Physician Administered Drug Program when billed with HCPCS code J9999 - Not Otherwise Classified, antineoplastic drugs.
Effective with date of service Oct. 16, 2018, the NC Medicaid and Health Choice programs cover immune globulin intravenous, human - ifas (Panzyga®) 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.