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Medicaid Bulletin

DHHS Provider Resources for Transition to Medicaid Managed Care

Tuesday, September 3, 2019

The Department of Health and Human Services (DHHS) recently launched an online “Provider Playbook” as part of its commitment to ensure providers have resources to help Medicaid beneficiaries transition smoothly to Medicaid Managed Care. This new Provider Playbook is a collection of information and tools specifically tailored to providers.

Infliximab-abda for Injection, for Intravenous Use (Renflexis® ) HCPCS code Q5104: Billing Guidelines

Tuesday, September 3, 2019

Effective with date of service Aug. 1, 2019, the North Carolina Medicaid and NC Health Choice programs cover infliximab-abda for injection, for intravenous use (Renflexis) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code Q5104 - Injection, infliximab-abda, biosimilar, (renflexis), 10 mg.

Update to Clinical Policy 15 Ambulance Services

Tuesday, September 3, 2019

Session Law 2018-5 Sec.11H.4 (see Appendix A) instructed the NC Department of Health and Human Services (DHHS) to submit to Centers for Medicare and Medicaid Services (CMS) for the necessary authority to establish Medicaid reimbursement for ambulance transports of Medicaid beneficiaries in behavioral health crisis to behavioral health clinics or other alternative locations effective July 1, 2019.

NC’s Transition to Medicaid Managed Care: The Crossover Communication Series

Tuesday, September 3, 2019

Supporting beneficiaries in their transition between the current fee-for-service delivery system and NC Medicaid Managed Care is called transition of care. The transitional period surrounding the launch of Medicaid Managed  Care is referenced as crossover.

Billing Code Update for Nurse Practitioners and Physician Assistants

Tuesday, September 3, 2019

NC Medicaid has received calls concerning claim denials for some services provided by nurse practitioners (NPs) and physician assistants (PAs). NC Medicaid has provided instructions to NCTracks on updating the claims processing system.

Clinical Coverage Policy Update

Tuesday, September 3, 2019

Several new or amended clinical coverage policies are available on NC Medicaid’s website.

Clinical Coverage Policy Update

Thursday, August 1, 2019

Policies (9) Outpatient Pharmacy Program and (8F) Research-based Behavioral Health Treatment (RB-BHT) for Autism Spectrum Disorder (ASD) are available on NC Medicaid's website.

Clinical Coverage Policy Update: 1A-12 Breast Surgeries

Thursday, August 1, 2019

Clinical Coverage Policy 1A-12 Breast Surgeries has been updated to reflect changes throughout the policy.

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

Thursday, August 1, 2019

The NC Medicaid EHR Incentive Payment System (NC-MIPS) is only accepting Program Year 2019 Stage 3 Meaningful Use (MU) attestations.

Sterilization Consent Form

Thursday, August 1, 2019

The sterilization consent form found on the U.S. Department of Health & Human Services (HHS) website has been updated.

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

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