At various times of the year, Medicaid providers may receive notification of participation letters from the DMA Office of Compliance and Program Integrity which facilitates audits from various auditing agencies, e.g. Office of the Inspector General, Office of Internal Auditor, and Office of State Auditor.
Medicaid Bulletin
Medicaid Bulletin Monthly Digest
Articles beginning January 2018 are available in the blog format.
Effective May 1, 2017, new pharmacy point of sale clinical edits for behavioral health medications were applied for pediatric and adult beneficiaries.
Registration is open for the February 2018 instructor-led provider training courses listed below. Slots are limited.
Effective Jan. 15, 2018, updates to Clinical Coverage Policy 3D, Hospice Services, are approved. The amended policy is posted to the North Carolina Medicaid website.
The following new or amended combined North Carolina Medicaid and NC Health Choice clinical coverage policies are available on North Carolina Medicaid’s Clinical Coverage Policy web pages.
If a provider’s enrollment application or Manage Change Request (MCR) is clean and does not contain errors, it will process more quickly. The NCTracks Enrollment Team identified commons errors that cause delays in processing applications and MCRs.
Effective with the date of service of April 30, 2018, the North Carolina Medicaid and N.C. Health Choice programs will be terminating Clinical Policy 1B-2, Rituximab (Rituxan), within the Physician Drug Program.
Effective with the date of service of April 31, 2018, the North Carolina Medicaid and N.C. Health Choice programs will be terminating Clinical Policy 1B-1, Botulinum Toxin Treatment, within the Physician Drug Program.
Botulinum Toxin Type A (Botox) HCPCS code J0585 Botulinum Toxin Type A, per unit: Billing Guidelines
Effective with the date of service April 30, 2018, the North Carolina Medicaid and N.C. Health Choice programs will be terminating Clinical Policy 1B-1, Botulinum Toxin Treatment, within the Physician Drug Program.
Effective with date of service Nov. 8, 2017, the North Carolina Medicaid program covers zoster vaccine recombinant, adjuvanted, suspension for intramuscular injection (Shingrix) for use in the Physician’s Drug Program (PDP) when billed with CPT code 90750 - Zoster (shingles) vaccine, (HZV), recombinant, sub-unit, adjuvanted, for intramuscular injection.