Medicaid Bulletin

Medicaid Bulletin Monthly Digest

Bulletins published prior to January 2019

Articles since January 2018 are available in the blog format below.

Proposed Clinical Coverage Policies for Public Comment

Tuesday, December 4, 2018

As of Dec. 1, 2018, there are no NC Medicaid policies posted for public comment.

Policy Clarification for Out-of-state Providers

Tuesday, December 4, 2018

Out-of-state providers, including border-area providers, must be enrolled in Medicare or their home-state Medicaid program to enroll in North Carolina Medicaid and NC Health Choice programs.

Money Follows the Person Project Update and Application Change

Tuesday, December 4, 2018

The Money Follows the Person Demonstration Project (MFP) team is preparing for the 2019-2023 Medicaid Transition Period and has updated its application for the coming year.

Summary of New or Amended Clinical Coverage Policies Posted Since Nov. 1, 2018

Tuesday, December 4, 2018

The following new or amended Medicaid and NC Health Choice clinical coverage policies were posted since Nov. 1, 2018.

Change In Scope of Services (CISS) Policy

Tuesday, December 4, 2018

In accordance with the North Carolina’s Medicaid State Plan, Federally Qualified Health Centers and Rural Health Centers may request a rate adjustment due to change in scope of services.

Telephonic Evaluation and Management is Again Being Offered for the 2018-2019 Influenza Season

Tuesday, December 4, 2018

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

Tuesday, December 4, 2018

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

Tuesday, December 4, 2018

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

Tuesday, December 4, 2018

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

Tuesday, December 4, 2018

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.

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