Medicaid Bulletin

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

If a provider’s enrollment application or Manage Change Request does not contain errors, it will process more quickly. The NCTracks Enrollment Team identified commons errors that cause delays in processing applications and MCRs.

North Carolina Medicaid will reprocess Medicare Part B Crossover Professional and Outpatient claims submitted to Medicare from Jan. 2, 2017, to Jan. 5, 2017.

As a reminder, providers are to request and obtain proper PA before services are scheduled or rendered. Contractually, CSRA (Medicaid’s fiscal vendor) has five business days (excluding holidays and weekends) to process a PA request once all required information is obtained.

Effective July 1, 2018, the North Carolina Medicaid and N.C. Health Choice programs will cover nusinersen injection, for intrathecal use (Spinraza) for use only in the Physician's Drug Program.

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

Effective with date of service March 8, 2018, the North Carolina Medicaid and N.C. Health Choice (NCHC) programs cover mometasone furoate sinus implant (Sinuva) for use in the Physician's Drug Program (PDP) when billed with HCPCS code J3490 - Unclassified drugs.

In accordance with the NC State Plan, Section 4.19-B, Section 3, Page 1, North Carolina Division of Medical Assistance (DMA) will revise rates for the following laboratory procedure codes: 81220, 81221, 81222, 81223, 81228, 81229, 81243, 81244, 81331, and 81507.

Effective with date of service May 1, 2018, the North Carolina Medicaid and N.C. Health Choice programs covers fosnetupitant and palonosetron for injection, for intravenous use (Akynzeo) for use in the Physician’s Drug Program when billed with HCPCS code J3490 - Unclassified drugs.

Effective with date of service April 1, 2018, the North Carolina Medicaid and N.C. Health Choice programs cover fibrinogen concentrate (human) lyophilized powder for reconstitution (Fibryga) for use in the Physician’s Drug Program when billed with HCPCS code J3590 - Unclassified biologics.