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Medicaid Bulletin

Medicaid Claims Documentation

Thursday, August 1, 2019

In accordance with 2 CFR part 200, subpart F, the North Carolina Office of the State Auditor (OSA) annually conducts the State Single Audit and accordingly selects a sample of NC Medicaid claims to determine if claims paid by the state were properly supported. Some claims documentation submitted were determined to be inadequate to support payment for services billed and were deemed an error.

Modification to Hospice Day Count for Two-Tier Calculation

Thursday, August 1, 2019

You are receiving this notice in regard to Hospice claims that were adjudicated in NCTracks beginning Jan. 1, 2016.

Americans with Disabilities Act

Thursday, August 1, 2019

The Americans with Disabilities Act (ADA), and other federal laws, prohibit discrimination and seek to ensure equal opportunity for persons with disabilities in employment, state and local government services, public accommodations, commercial facilities and transportation.

Provider Enrollment for Presumptive Eligibility Transitioning to NCTracks

Thursday, August 1, 2019

Effective July 28, 2019, the presumptive eligibility provider enrollment process will be transitioned from NC Medicaid to NCTracks. NCTracks will assume the enrollment process for providers of presumptive eligibility for pregnant women and hospital providers of presumptive eligibility for Medicaid programs.

Disaster Relief Enrollment Application Streamlined

Thursday, August 1, 2019

Effective July 28, 2019, an expedited disaster relief provider enrollment application process will be available during times of disaster such as a State of Emergency. This abbreviated enrollment application will collect limited information to enroll a provider for a limited time (120 days) and will be available to in-state, out-of-state (OOS) and border providers that are not yet enrolled in NC Medicaid, including individual providers and organizations.

Approved PHP Provider Contract Templates as of June 21, 2019

Monday, July 1, 2019

The Contract for Prepaid Health Plan Services (the State Contract) between the Department of Health and Human Services (the Department) and the selected Medicaid Managed Care plans (i.e., Prepaid Health Plans or PHPs) indicates that contracts between PHPs and providers shall comply with the terms of the State Contract and must be approved by the Department.

Romosozumab-aqqg injection, for subcutaneous use (Evenity™) HCPCS code J3590: Billing Guidelines

Monday, July 1, 2019

Effective with date of service April 11, the North Carolina Medicaid and NC Health Choice programs cover romosozumab-aqqg injection, for subcutaneous use (Evenity) for use in the Physician Administered Drug Program when billed with HCPCS code J3590 - Unclassified biologics.

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

Monday, July 1, 2019

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

Trastuzumab and hyaluronidase-oysk injection, for subcutaneous use (Herceptin Hylecta™) HCPCS code J9999: Billing Guidelines

Monday, July 1, 2019

Effective with date of service April 5, 2019, the North Carolina Medicaid and NC Health Choice programs cover trastuzumab and hyaluronidase-oysk injection, for subcutaneous use (Herceptin Hylecta) for use in the Physician Administered Drug Program when billed with HCPCS code J9999 - Not otherwise classified, antineoplastic drugs.

Clinical Coverage Policy Update

Monday, July 1, 2019

New or amended clinical coerage policies are available on NC Medicaid's website.

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