Medicaid Bulletin

Medicaid Bulletin Monthly Digest

Bulletins published prior to January 2019

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

Billing Code Update (February 2019)

Monday, April 1, 2019

North Carolina Medicaid has received calls concerning claim denials for some services provided by nurse practitioners (NPs) and physician assistants (PAs).

Medicaid has provided instructions to NCTracks and the following procedure code list has been updated recently to include additional NP and PA taxonomies.

NCTracks Provider Training Available in April 2019

Monday, April 1, 2019

Registration is open for the April 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.

Payment Error Rate Measurement Changes

Monday, April 1, 2019

The Payment Error Rate Measurement (PERM) is an audit program developed and implemented by the Centers for Medicare & Medicaid Services (CMS) as required by the Improper Payments Information Act (IPIA) of 2002. It is used nationwide to review beneficiary eligibility determinations and claims payments made by North Carolina Medicaid and NC Health Choice to ensure that states only pay for appropriate claims. A national report is distributed outlining the various error rates among states.

Billing Code Update (April 2019)

Monday, April 1, 2019

North Carolina Medicaid has received calls concerning claim denials for some services provided by nurse practitioners (NPs) and physician assistants (PAs).

North Carolina Medicaid has provided instructions to NCTracks and the following procedure code list has been updated recently to include additional NP and PA taxonomies.

Advanced Medicaid Home Update

Monday, April 1, 2019

Nearly 2,900 North Carolina Medicaid providers have already certified as Advanced Medical Homes (AMHs). It is important that practices understand the meaning of this designation and the associated requirements on primary care providers (PCPs).

Clinical Coverage Policy Update

Monday, April 1, 2019

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

Centers for Medicare and Medicaid Services (CMS) Approved the State Plan Amendment for Adult Optical Services

Friday, March 1, 2019

NC Medicaid received approval from CMS for the State Plan Amendment for Adult Optical Services. Effective Feb. 10, 2019, providers may bill for routine eye exams and visual aids for adult Medicaid beneficiaries with dates of service on or after Jan. 1, 2019. 

Request for Proposal for Independent Assessment Entity for Long-Term Services and Supports

Friday, March 1, 2019

NC Medicaid has approved the release of a Request for Proposal (RFP) for an independent assessment entity (IAE) that will streamline access to Medicaid Long-Term Services and Supports (LTSS) effective July 2019. The IAE will provide beneficiaries a much-needed single point of entry for accessing Medicaid LTSS services and streamline the processes between initial contact and service enrollment.

Summary of New or Amended Clinical Coverage Policies Posted Since Jan. 1, 2019

Friday, March 1, 2019

The following new or amended clinical coverage policies are available on NC Medicaid’s website:

Optical Services are Non-Covered for Medicare Qualified Beneficiary (MQB), Family Planning Waiver (MAFD), and Program of All-inclusive Care for the Elderly (PACE)

Friday, March 1, 2019

Under the MQB Medicare Eligibility Codes, Medicaid pays only for Medicare Part B premiums or premiums, deductibles, and coinsurance for charges covered by Medicare. Routine eye exams, refraction only and visual aids are not covered by Medicare for MQB beneficiaries.  Therefore, MQB beneficiaries are not eligible for Medicaid optical services.   

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