Effective with date of service Jan. 3, 2019, the North Carolina Medicaid and NC Health Choice programs cover pegfilgrastim-cbqv injection, for subcutaneous use (Udenyca) for use in the Physician Administered Drug Program when billed with HCPCS code Q5111 - Injection, pegfilgrastim-cbqv, biosimilar, (Udenyca), 0.5 mg.
Medicaid Bulletin
Medicaid Bulletin Monthly Digest
Articles beginning January 2018 are available in the blog format.
The Payment Error Rate Measurement (PERM) is an audit program developed and implemented by the Centers for Medicare & Medicaid Services (CMS) as required by the Improper Payments Information Act (IPIA) of 2002. It is used nationwide to review beneficiary eligibility determinations and claims payments made by North Carolina Medicaid and NC Health Choice to ensure that states only pay for appropriate claims. A national report is distributed outlining the various error rates among states.
Nuzyra is available as 100 mg of omadacycline (equivalent to 131 mg omadacycline tosylate) as a lyophilized powder in a single dose vial for reconstitution and further dilution before intravenous infusion.
Beginning in April, participating health care providers in the state-designated health information exchange (HIE), NC HealthConnex, will be moving to a new HIE platform.
Registration is open for the April 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 Mar. 4, 2019, NC Medicaid implemented functionality in QiRePort allowing providers to submit the Internal Quality Improvement Program Attestation (NC Medicaid-3136) and Session Law 2013-306 PCS Training Attestation (NC Medicaid-3085) Forms via upload.
Effective May 1, 2019, beneficiaries requesting Personal Care Services must use the updated NC Medicaid-3051 Request for Independent Assessment for Personal Care Services Attestation of Medical Need Form. This form is a revision of the currently used NC Medicaid-3051 Form. The current form will be accepted by the Independent Assessment Entity through July 1, 2019.
Effective with date of service of Feb. 4, 2019, the North Carolina Medicaid and NC Health Choice programs cover fluocinolone acetonide intravitreal implant (Yutiq) for use in the Physician Administered Drug Program when billed with HCPCS code J7313 Injection, fluocinolone acetonide, intravitreal implant, 0.01 mg.
New or amended clinical coverage policies are available on NC Medicaid’s website.
The Department recognizes that the move to managed care may impose additional administrative burdens and program complexity to the work NC providers already do. To mitigate the administrative burden on providers as NC Medicaid transitions to managed care, the Department procured a contractor to supplement the state’s existing provider enrollment data. This data will be combined with provider enrollment information NC Medicaid has on file to support the Prepaid Health Plans’ (PHPs’) ability to help determine which providers to contract with.