Medicaid Bulletin

Medicaid Bulletin Monthly Digest

Medicaid Bulletin Archive

Articles beginning January 2018 are available in the blog format.

Billing Guidance for Children’s Developmental Services Agency Providers
Claims may be submitted to NCTracks for all IFSP services for dates of service starting on July 1, 2021.
Procedures for Prior Authorization of Palivizumab (Synagis®) for Respiratory Syncytial Virus Season 2021-2022
Coverage season will begin Aug. 15, 2021
Prior Authorization for Physician Administered Drug Program
Not required for medications administered at the provider’s office or outpatient hospital clinic settings and billed as part of the professional claim (Physician Administered Drug Program).
New 2023 Deadline for Connecting to HIE Network Absolves Need for Hardship Extensions
The extension granted through the hardship process is now matched by the extension granted through new legislation.
Tailored Care Management Update: AMH+/CMA Certification Round One Desk Reviews Completed
NC Medicaid advanced 54 providers to the site review stage.
Potential Clinically Integrated Networks or Other Partners Statement of Interest
All responses have been received and are available.
Confirming Medicaid Coverage for Beneficiaries
Providers and pharmacies should always use NCTracks to confirm eligibility.
What Providers Need to Know After the July 1, 2021 Full Launch of Electronic Visit Verification
The State solution for reporting electronic visit verification and aggregation is Sandata.
Prior Authorizations for Medically Necessary Contact Lenses When a Beneficiary Transitions NC Medicaid Direct
Providers must submit a contact lens prior approval request to NCTracks for a beneficiary who has transferred back to NC Medicaid Direct.
Prior Authorizations Covered When a Beneficiary Transitions to NC Medicaid Direct
When an NC Medicaid Managed Care member becomes part of a population exempted or excluded, they are disenrolled and transition to NC Medicaid Direct.