Medicaid Bulletin

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

Wednesday, May 1, 2019

The NC Medicaid EHR Incentive Program is no longer accepting Program Year 2018 attestations. Program Year 2018 attestations are being processed in the order they were received. Attestations received in April may take up to eight weeks to be processed from the date the signed attestation was received. 

Recovery Audit Contractor

Wednesday, May 1, 2019

Health Management System is under contract with North Carolina Medicaid as NC Medicaid’s Recovery Audit II Contractor, pursuant to Section 6411 of the Patient Protection and Affordable Care Act of 2010.

SPECIAL BULLETIN: Provider Data Contractor for Medicaid Managed Care: Guidance for Providers

Wednesday, April 24, 2019

To minimize the administrative burden on providers as NC Medicaid transitions to managed care, the Provider Data Contractor (PDC) will supplement the state’s existing provider credentialing data to the Prepaid Health Plans (PHPs). This will support the PHP’s ability to make quality determinations during Medicaid Managed Care provider network contracting activities. The PHPs will make their quality determination policy public once approved by NC Medicaid.

SPECIAL BULLETIN: Recommended Updates to the North Carolina Medicaid and NC Health Choice Preferred Drug List (PDL)

Friday, April 5, 2019

Recommended updates to the NC Medicaid and Health Choice Preferred Drug List (PDL) as approved by the NC Pharmacy and Therapeutics (P&T) Committee and the NC Physician Advisory Group (PAG) were posted for the required 45-day public comment period on Apr. 2, 2019.

Preadmission Screening Resident Review (PASRR) Program Update

Monday, April 1, 2019

Effective Dec. 1, 2018, the North Carolina Medicaid Uniform Screening Tool (NCMUST) application and operation of the Level 1 PASRR screen process transitioned from a NC Medicaid vendor to NC DHHS ITD and NC Medicaid.  The transition enables NC DHHS to achieve a more efficient screening process for PASRRs and provide NCDHHS with direct knowledge of issues and barriers that may impact the timely processing of PASRR Level 1 screens and Level 2 evaluations. 

Pegfilgrastim-cbqv injection, for subcutaneous use (Udenyca™) HCPCS code Q5111: Billing Guidelines

Monday, April 1, 2019

Effective with date of service Jan. 3, 2019, the North Carolina Medicaid and NC Health Choice programs cover pegfilgrastim-cbqv injection, for subcutaneous use (Udenyca) for use in the Physician Administered Drug Program when billed with HCPCS code Q5111 - Injection, pegfilgrastim-cbqv, biosimilar, (Udenyca), 0.5 mg.

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

Monday, April 1, 2019

April is the last month to submit an attestation for Program Year 2018. The NC Medicaid EHR Incentive Payment System (NC-MIPS) will close for Program Year 2018 at midnight on Apr. 30, 2019. After that no changes can be made. Eligible professionals (EP) are strongly advised to review their attestation and documentation for accuracy and completeness

Regional Provider Training

Monday, April 1, 2019

Personal Care Services (PCS) regional training sessions will be held May 13-22, 2019.  Registration begins at 8 a.m. and training will be held from 9 a.m. to 1:30 p.m. Training sessions are free, but registration is required.

Fluocinolone acetonide intravitreal implant (Yutiq™) HCPCS code J7313 Injection, fluocinolone acetonide, intravitreal implant, 0.01 mg: Billing Guidelines

Monday, April 1, 2019

Effective with date of service of Feb. 4, 2019, the North Carolina Medicaid and NC Health Choice programs cover fluocinolone acetonide intravitreal implant (Yutiq) for use in the Physician Administered Drug Program when billed with HCPCS code J7313 Injection, fluocinolone acetonide, intravitreal implant, 0.01 mg.

New Platform for NC HealthConnex to Launch in April

Monday, April 1, 2019

Beginning in April, participating health care providers in the state-designated health information exchange (HIE), NC HealthConnex, will be moving to a new HIE platform.

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