Medicaid Bulletin

An amended version of Clinical Coverage Policy 5A-2, Respiratory Equipment and Supplies with an effective date of April 1, 2021, was posted to the NC Medicaid Clinical Coverage Policy web page. 

NC Medicaid implemented system changes on May 9, 2021, requiring providers to keep credentials current on their NCTracks provider enrollment record. 

Affected providers should resubmit claims that were denied for procedure code 58661 at this time.  

NC Medicaid has published updated guidance on Tailored Care Management, including updates on Advanced Medical Home + (AMH+)/Care Management Agency (CMA) Certification, capacity building and rates.

NC Medicaid will end the pay and report period for Electronic Visit Verification (EVV) claims on May 31, 2021. A stakeholder meeting will be held on Friday, May 21, 2021, at 10 a.m. to share EVV implementation updates and provide training to support provider readiness for June 1, 2021.

June 30, 2021, is the implementation date of Electronic Visit Verification (EVV) for the Innovations waiver, Traumatic Brain Injury (TBI) waiver and (b)(3) services administered by the LME/MCOs.

NCDHHS is in its final week of open enrollment for NC Medicaid Managed Care. Through Friday, May 14, beneficiaries can choose a primary care provider (PCP) and a health plan for their families’ care in preparation for the launch of NC Medicaid Managed Care on July 1. 

DHHS has developed a reconsideration process for providers’ use following the validation of the provider submitted attestation information.

The American Rescue Plan Act that was recently enacted includes several changes to COVID-19 Medicaid policy. As of March 11, 2021, North Carolina will be covering all approved COVID-19 vaccines for limited benefit eligibility groups.

On May 9, 2021, NC Medicaid is taking additional steps to ensure providers meet their contractual obligation to keep credentials current on their NCTracks enrollment. NCTracks will generate a notification to providers at 60, 30 and 14 calendar days prior to the expiration date of the credential; and will begin a process of suspension if a provider fails to update their credential.