Medicaid Bulletin

Community Inclusion Addendum Added to Tailored Care Management Provider Manual

Friday, March 19, 2021

DHHS is releasing an addendum to the Tailored Care Management Provider Manual on community inclusion that addresses the in-reach and transition requirements for Advanced Medical Home Plus practices and Care Management Agencies delivering Tailored Care Management.

Healthy Opportunities Screening, Assessment and Referral Payment Claims Issue

Thursday, March 18, 2021

It has come to the attention of NC Medicaid that Edit 02088, which enforces a rule that coverage of procedure code G9919 for Healthy Opportunities Screening, Assessment and Referrals (HOSAR) positive screenings, be limited to providers affiliated with Carolina Access II based on the rendering provider NPI. 

Electronic Visit Verification Implementation for Innovations and TBI Waivers Administered by LME-MCOs

Wednesday, March 17, 2021

The implementation date of Electronic Visit Verification for LME-MCOs has been extended to June 30, 2021.

Medicaid Managed Care Provider Update

Tuesday, March 16, 2021

Key Dates for Transitioning to Medicaid Managed Care, PHP Quick Reference Guides Created, Provider Contracting Reminders, Provider Playbook Updates, Medicaid Contacts Reference Guide for Beneficiaries, Help Center, Webinars, Virtual Office Hours, Meet and Greet Sessions. 

Interim Process for Comprehensive Independent Assessment Entity Requests

Tuesday, March 16, 2021

Beginning April 1, 2021, NC Medicaid will begin strictly applying its timeline business rules for the receiving, processing and closing out referral requests.

Cost of Dispensing Survey

Tuesday, March 16, 2021

The five-year cost of dispensing (COD) survey has been completed for NC pharmacies.

SPECIAL BULLETIN COVID-19 #161: Billing for Administration of Monoclonal Antibodies

Monday, March 15, 2021

The U.S. Food and Drug Administration has issued an Emergency Use Authorization for the unapproved products, bamlanivimab and etesevimab to be administered together for qualifying patients. 

SPECIAL BULLETIN COVID-19 #160: Janssen COVID-19 Vaccine HCPCS Code 91303 and 0031A Billing Guidelines

Monday, March 15, 2021

Janssen COVID-19 vaccine is authorized for use under an Emergency Use Authorization (EUA) for active immunization to prevent coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in individuals 18 years of age and older.

NCDHHS Launches Statewide Open Enrollment for NC Medicaid Managed Care

Monday, March 15, 2021

NCDHHS announced today the launch of statewide open enrollment for NC Medicaid Managed Care. Beneficiaries can enroll through May 14, 2021 in preparation for NC Medicaid Managed Care launch on July 1, 2021. 

New and Amended Clinical Coverage Policies

Tuesday, March 9, 2021

The following new or amended clinical coverage policies are available on the Clinical Coverage Policies web page on NC Medicaid’s website. 

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