Medicaid Bulletin

The Department recognizes that the move to managed care may impose additional administrative burdens and program complexity to the work NC providers already do. To mitigate the administrative burden on providers as NC Medicaid transitions to managed care, the Department procured a contractor to supplement the state’s existing provider enrollment data. This data will be combined with provider enrollment information NC Medicaid has on file to support the Prepaid Health Plans’ (PHPs’) ability to help determine which providers to contract with.

North Carolina Medicaid has received calls concerning claim denials for some services provided by nurse practitioners (NPs) and physician assistants (PAs).

Medicaid has provided instructions to NCTracks and the following procedure code list has been updated recently to include additional NP and PA taxonomies.

North Carolina Medicaid has received calls concerning claim denials for some services provided by nurse practitioners (NPs) and physician assistants (PAs).

North Carolina Medicaid has provided instructions to NCTracks and the following procedure code list has been updated recently to include additional NP and PA taxonomies.

Nearly 2,900 North Carolina Medicaid providers have already certified as Advanced Medical Homes (AMHs). It is important that practices understand the meaning of this designation and the associated requirements on primary care providers (PCPs).

NC Medicaid has developed a general overview and topic-based webinar series that will educate providers to effectively support their transition to Medicaid Managed Care. General webinars are designed to give providers an overview of major changes and important things to know while the focused, topical webinar series will offer a deeper dive on specific topics.

Session Law 2017-57, Section 11H.13/(a) was amended to appropriate funding to be used to increase the rate for in-home aide services to no more than three dollars and ninety cents ($3.90) paid per 15-minute billing unit provided under the Community Alternatives Program for Disabled Adults (CAP/DA) waiver pursuant to Clinical Coverage Policy 3K-2, effective Jan. 1, 2019.

A renewal application for § 1915 (c) Home and Community-Based Services (HCBS) waiver for the Community Alternatives Program for Disabled Adults (CAP/DA) was submitted to the Centers for Medicare & Medicaid Services (CMS) on Mar. 1, 2019 for review and approval.

There are only two months left to submit an attestation for Program Year 2018. The NC Medicaid EHR Incentive Payment System (NC-MIPS) will close for Program Year 2018 at midnight on April 30, 2019. After that, no changes can be made. 

The following new or amended clinical coverage policies are available on NC Medicaid’s website:

Effective Jan. 31, 2019, NC Medicaid’s Community Alternatives Program for Children (CAP/C) approves specialized medical equipment and supplies for an adaptive car seat and a vehicular transport vest for participants in CAP/C when all qualifying conditions are met per the CAP/C Clinical Coverage Policy, 3K-1.