Medicaid Bulletin

Effective Sept. 15, 2018, Clinical Coverage Policy 10A, Outpatient Specialized Therapies, was updated to increase therapy visit limits for recipients 21 years of age and older.

Effective for dates of service on or after Oct. 1, 2018, the following DRG classifications specific to LARCs will be added to the current Grouper 36 version within NCTracks for claims reimbursement.

Pursuant to Section 6.a. of the NCDHHS Provider Administrative Participation Agreement, providers are required to update their enrollment records in NCTracks within 30 days of a change.

Providers are reminded that NC Medicaid flexibilities due to Hurricane Florence end on Oct. 5, 2018. For additional information, please refer to the Sept. 27, 2018 Special Medicaid Bulletin.

In April 2018, the recredentialing notification and suspension process was modified. The previous rule to extend the recredentialing due date if a Manage Change Request Application is "In Review" has been removed.

Personal Care Services (PCS) regional training sessions will be held Oct. 18-Nov. 1, 2018.

Proposed new or amended Medicaid and NC Health Choice clinical coverage policies are posted for comment throughout the month. Visit the Proposed Medicaid and NC Health Choice Policies for current posted policies and instructions to submit a comment.

The Department of Health and Human Services is implementing the Referral Screening Verification Process for individuals being considered for admission to an Adult Care Home effective Nov. 1, 2018.

Effective with date of service Aug. 17, 2018, the Medicaid and NC Health Choice programs cover plazomicin injection, for intravenous use (Zemdri) for use in the Physician's Drug Program when billed with HCPCS code J3490-Unclassified drugs.

Effective with date of service Sept. 5, 2018, the Medicaid and NC Health Choice programs cover patisiran lipid complex injection, for intravenous use (Onpattro) for use in the Physicians Drug Program (PDP) when billed with HCPCS code J3490 - Unclassified drugs.