Medicaid Bulletin

NC Medicaid will reprocess claims with dates of service between Jan. 1, 2019 and Sept. 3, 2019, paid to primary care physicians, nurse practitioners and physician assistants submitted with E&M codes ranging from 99201 to 99499 and the corresponding taxonomies as defined in Section 1202 of the Affordable Care Act (ACA).

*NOTE: THE CONTENT OF THIS BULLETIN HAS BEEN UPDATED. REFER TO THE SEPT. 24, 2019 MEDICAID SPECIAL BULLETIN FOR REVISED FLEXIBILITIES.

This Special Bulletin includes several articles regarding Hurricane Dorian.

As of the end of August 2019, several issues have been identified with the search function in the Enrollment Broker Provider Directory, including duplicate results, and difficulty finding doctors based on specific criteria such as gender or name.

The NC Medicaid EHR Incentive Payment System (NC-MIPS) is only accepting Program Year 2019 Stage 3 Meaningful Use (MU) attestations. All eligible professionals (EPs) attesting in Program Year 2019 will be required to attest to Stage 3 MU and use a 2015 Edition of certified EHR technology (CEHRT).

Session Law 2018-5 Sec.11H.4 (see Appendix A) instructed the NC Department of Health and Human Services (DHHS) to submit to Centers for Medicare and Medicaid Services (CMS) for the necessary authority to establish Medicaid reimbursement for ambulance transports of Medicaid beneficiaries in behavioral health crisis to behavioral health clinics or other alternative locations effective July 1, 2019.

The Department of Health and Human Services (DHHS) will extend open enrollment for Medicaid beneficiaries and move to a statewide transition to managed care on Feb. 1, 2020.

Hematopoietic Stem Cell Transplantation (HSCT) clinical coverage policies have been revised. The revisions, which will become effective Oct. 1, 2019 are outlined below:

North Carolina’s state-designated health information exchange, NC HealthConnex, was created in 2015 by the North Carolina General Assembly to help bridge the gap between distinct electronic health record systems and health care networks to support whole patient care. With over seven million unique patient records and growing, NC HealthConnex is working to connect the state’s health care providers to deliver a holistic view of a patient’s record.

The North Carolina Division of Health Benefits (DHB) would like to reiterate the 340B provider and claim submission requirements for both the outpatient pharmacy and Physician’s Drug Program (PDP). 

Effective with date of service June 11, 2019, the North Carolina Medicaid and NC Health Choice programs cover polatuzumab vedotin-piiq for injection, for intravenous use (Polivy) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J9999 - Not otherwise classified, antineoplastic drugs.