Per Session Law (S.L.) 2015-241, as of June 1, 2018, hospitals, mid-level physicians and nurse practitioners who currently have an electronic health record system must be connected to NC HealthConnex to continue to receive payments for Medicaid and NCHC services.
Medicaid Bulletin
Medicaid Bulletin Monthly Digest
Articles beginning January 2018 are available in the blog format.
The Department of Health and Human Services, Division of Medical Assistance, provides notice of its intent to amend the Medicaid State Plan to increase the rates for metabolic formula – Durable Medical Equipment.
By July 1, 2018, Medicaid behavioral health providers added to NCTracks by their current Local Management Entity/Managed Care Organization Provider Upload Process must complete re-verification.
Effective May 1, 2018, North Carolina Medicaid will cover digital breast tomosynthesis (3D tomosynthesis) for both screening and diagnostic mammography.
The following new or amended combined North Carolina Medicaid and NC Health Choice clinical coverage policies are available on Medicaid’s Clinical Coverage Policy web pages.
The implementation of ICD-10-CM allows specificity for accurate coding, resulting in greater justification of medical necessity. A provider’s documentation must include details to completely depict the nature of a beneficiary’s diagnosis and procedures performed.
The NC Division of Medical Assistance (DMA) currently recognizes CPT Code 27216 (Percutaneous skeletal fixation of posterior pelvic bone fracture and/or dislocation, for fracture patterns that disrupt the pelvic ring, unilateral).
Topics include: list of providers due for re-credentialing, changes to re-credentialing process and changes to ongoing verification process.
Effective Feb. 1, 2018, Clinical Coverage Policy 1A-42, Balloon Ostial Dilation, was revised to include new coverage of CPT code 31298 (balloon dilation of frontal and sphenoid sinus).
On July 21, 2017, the Centers for Medicare & Medicaid Services notified North Carolina Medicaid that its State Plan Amendment (SPA TN17-0003) had been reviewed and was approved effective April 1, 2017.