Medicaid Bulletin

Medicaid Bulletin Monthly Digest

Bulletins published prior to January 2019

Articles since January 2018 are available in the blog format below.

Prior Approval Reminders

Wednesday, January 9, 2019

As a reminder, providers are to request and obtain proper prior authorization before services are scheduled or rendered. Contractually, GDIT has five business days (excluding holidays and weekends) to process a medical PA request once all required information is obtained. Pharmacy PAs are processed within 24 hours. Medical necessity cannot be determined with a partial or incomplete clinical picture.

Elapegademase-lvlr injection, for intramuscular use (Revcovi™) HCPCS code J3590: Billing Guidelines

Wednesday, January 9, 2019

Effective with date of service Oct. 22, 2018, the NC Medicaid and Health Choice programs cover eravacycline for injection, for intravenous use (Xerava) for use in the Physician Administered Drug Program when billed with HCPCS code J3490 - Unclassified Drugs. Xerava is available as a 50 mg single-dose vial.

Moxetumomab Pasudotox-tdfk for Injection, for intravenous use (Lumoxiti™) HCPCS code J9999: Billing Guidelines

Wednesday, January 9, 2019

Effective with date of service Oct. 22, 2018, the NC Medicaid and Health Choice programs cover moxetumomab pasudotox-tdfk for injection, for intravenous use (Lumoxiti™) for use in the Physician Administered Drug Program when billed with HCPCS code J9999 - Not Otherwise Classified, antineoplastic drugs.

Updates to the NC Medicaid Electronic Health Record (EHR) Incentive Program

Wednesday, January 9, 2019

There are only four months left to submit an attestation for Program Year 2018. Attestations submitted after Feb. 28, 2019 are not guaranteed to be reviewed by program staff prior to close of Program Year 2018. Providers have until April 30, 2019 to submit a complete and accurate attestation for Program Year 2018. After that no changes can be made.

Update to Clinical Policy 1E-7, Family Planning Services

Wednesday, January 9, 2019

Clinical Policy 1E-7, Family Planning Services, has been revised effective Jan. 1, 2019.

Filgrastim-aafi injection, for subcutaneous or intravenous use (Nivestym™) HCPCS code Q5110: Billing Guidelines

Wednesday, January 9, 2019

Effective with date of service Oct 3, 2018, the NC Medicaid and Health Choice programs cover filgrastim-aafi injection, for subcutaneous or intravenous use (Nivestym) for use in the Physician Administered Drug Program when billed with HCPCS code Q5110 - Injection, Filgrastim-aafi, Biosimilar, (Nivestym), 1 microgram. Nivestym is available in a single-dose prefilled syringe containing either 300 mcg/0.5 mL or 480 mcg/0.8 mL.

NCTracks Provider Training Available in January 2019

Wednesday, January 9, 2019

Registration is open for the January 2019 instructor-led provider training courses listed below. Slots are limited. WebEx courses can be attended remotely from any location with a telephone, computer and internet connection. Please note that the WebEx information has changed. 

Immune globulin intravenous, human - ifas (Panzyga®) HCPCS code J1599: Billing Guidelines

Wednesday, January 9, 2019

Effective with date of service Oct. 16, 2018, the NC Medicaid and Health Choice programs cover immune globulin intravenous, human - ifas (Panzyga®) for use in the Physician Administered Drug Program when billed with HCPCS code J1599 - Injection, Immune Globulin, Intravenous, Non-lyophilized (e.g. liquid), Not Otherwise Specified, 500 mg.

Special Bulletin: Review of Durable Medical Equipment Rates

Friday, December 21, 2018

NC Medicaid has been reviewing the Medicaid Durable Medical Equipment rates to comply with the new Centers for Medicare and Medicaid Upper Payment Limit requirements. While further review is needed, NC Medicaid wanted to publish this bulletin to provide a status update.

Special Bulletin: Optical Services Covered for Adult Medicaid Beneficiaries Effective Jan. 1, 2019

Thursday, December 20, 2018

Effective Jan. 1, 2019, optical services shall be covered for adult Medicaid beneficiaries in accordance with S. L. 2018-97, Part III, Section 11H.13.(c). However, Centers for Medicare and Medicaid Services (CMS) approval of the corresponding State Plan Amendment is pending.

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