Medicaid Bulletin
Medicaid Bulletin Monthly Digest
Bulletins published prior to January 2019
Articles since January 2018 are available in the blog format below.
Telephonic Evaluation and Management is Again Being Offered for the 2018-2019 Influenza Season
In response to the anticipated higher than normal number of influenza cases this coming season, effective December 1, 2018, North Carolina Medicaid is offering telephonic evaluation and management services to beneficiaries who are actively experiencing flu-like symptoms.
Clinical Coverage Policy (CCP) 1-H, Telemedicine and Telepsychiatry
System changes have been completed to allow non-psychiatric Nurse Practitioners and Physician Assistants to receive reimbursement for CPT codes 90791 – Psychiatric Diagnostic Evaluation and 90792 – Psychiatric Diagnostic Evaluation with Medical Servicess when provided via telemedicine/telepsychiatry.
Preadmission Screening Resident Review (PASRR) Program Update
This article talks about the new help desk number for PASRR, the new fax number for PASRR-related documents and uploading PASRR-related documents to NCMUST.
Hospital Outpatient Claims Audits Resume
NC Medicaid has instructed Health Management System (HMS) to resume audits of hospital outpatient claims. These reviews are commencing now, as the claims adjustment reason code issue has been resolved.
Diagnosis Codes Being Added to Exemption List for the Annual Office Visit Limit
Medicaid has designated specific ICD-10-CM diagnosis codes that do not count toward the annual visit limitation. These codes are reviewed regularly and updated as appropriate.
Mogamulizumab-kpkc Injection, for Intravenous Use (Poteligeo®) HCPCS Code J9999: Billing Guidelines
Effective with date of service Oct. 3, 2018, North Carolina Medicaid and NC Health Choice programs cover mogamulizumab-kpkc injection, for intravenous use (Poteligeo), for use in the Physician Administered Drug Program when billed with HCPCS code J9999 - Not Otherwise Classified, Antineoplastic Drugs.
Proposed Clinical Coverage Policies for Public Comment
Proposed Clinical Coverage Policies for Public Comment
Money Follows the Person Project Update and Application Change
The Money Follows the Person Demonstration Project is preparing for the 2019-2023 Medicaid Transition Period and has updated its application for the coming year.
Errors on Provider Records in NCTracks
Enrollment applications submitted with incorrect data including name, social security number and date of birth result in application denials and withdrawals. As a result, providers must submit new applications and pay any applicable fees.
Summary of New or Amended Clinical Coverage Policies Posted Since Oct. 1, 2018
The following new or amended Medicaid and NC Health Choice clinical coverage policies were posted since Oct. 1, 2018. Visit the NC Medicaid website to view the policies.
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