Medicaid Bulletin

Effective July 1, 2018, Cologuard (CPT code 81528) has been approved for colorectal cancer screening.

Note: This article was originally published in the June 2018 Medicaid Bulletin with a clarification that only high-risk providers must obtain fingerprints.

Registration is open for the July 2018 instructor-led provider training courses listed below. Slots are limited.

Centers for Medicare & Medicaid Services is streamlining the Electronic Health Record Incentive Program. The goal is to move the program beyond requirements for meaningful use to increase focus on interoperability and improving patient access to health information.

Effective Aug. 1, 2018, North Carolina Medicaid will make a change to the North Carolina Medicaid and N.C. Health Choice Preferred Drug List (PDL) in the Antihyperkinesis/Attention Deficit Hyperactivity Disorder (ADHD) class.

These guidelines assist with claim submissions for dually eligible beneficiaries. This information addresses situations known to affect a significant number of claims. It is not feasible to provide an all-inclusive list due to the variable nature of the programs.

Medicaid’s Third-Party Liability contractor, Health Management Systems, Inc., will implement a Commercial Insurance Disallowance project to streamline North Carolina’s coordination of benefits and direct billing processes. The expected date for implementation is Oct. 1, 2018.

Note: This article was originally published as a Special Bulletin in January 2018, with updates regarding clinical pharmacist practitioners.

Providers must submit a Fingerprinting Criminal Background Check application within 30 days of receiving the request notification to avoid being terminated for cause.

Effective Jan. 1, 2018, North Carolina Medicaid increased the rates for mammography procedure codes 77065, 77066, and 77067. Medicaid has identified the claims that have been affected by this change.