Medicaid Bulletin

Effective with date of service June 9, 2021, the Medicaid and NC Health Choice programs cover amivantamab-vmjw injection, for intravenous use (Rybrevant) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J9999 – Not otherwise classified antineoplastic drugs.

Effective July 1, 2021, some Medicaid beneficiaries receiving Personal Care Services (PCS) transitioned from NC Medicaid Direct to receiving services through an NC Medicaid Managed Care health plan.

Health plans have identified a common billing error of providers submitting professional and institutional EDI claims.

Data system guidance and strategy Q&As are now available

Effective July 29, 2021, Session Law 2021-62 (NC Senate Bill 594), repeals portions of the 2020 COVID-19 Recovery Act that permitted the temporary lifting of certain enrollment requirements for providers enrolling in NC Medicaid during the global healthcare emergency.

Effective with date of service May 17, 2021, Medicaid and NC Health Choice cover dostarlimab-gxly injection.

This Special Bulletin is being released to inform NC Medicaid providers of COVID-19 rate reimbursement that providers will receive from Prepaid Health Plans (PHPs) under NC Medicaid Managed Care.

ADDENDUM to Special Bulletin #168: The addendum was updated to include information regarding guidance on billing and coding criteria, guidance for parents, counseling methods, reimbursement ranges and the time frame during which the code is valid.

This Bulletin includes key milestone dates for NC Medicaid Managed Care, Provider Playbook updates, prior authorization updates, contracting reminders, information about health plan events, the provider ombudsman and upcoming AHEC events and webinars. It also includes information about the Provider and Health Plan Lookup Tool, PHP Quick Reference Guide and the NC Medicaid Help Center.

This is a reminder to include taxonomy codes when submitting claims to PHPs, either by individual providers or through a trading partner.