Medicaid Bulletin
Centralized Provider Credentialing
The Department recognizes that the move to managed care may impose additional administrative burdens and program complexity to the work NC providers already do. To mitigate the administrative burden on providers as NC Medicaid transitions to managed care, the Department procured a contractor to supplement the state’s existing provider enrollment data. This data will be combined with provider enrollment information NC Medicaid has on file to support the Prepaid Health Plans’ (PHPs’) ability to help determine which providers to contract with.
NC Medicaid-3136 and 3085 Form Submission
Effective Mar. 4, 2019, NC Medicaid implemented functionality in QiRePort allowing providers to submit the Internal Quality Improvement Program Attestation (NC Medicaid-3136) and Session Law 2013-306 PCS Training Attestation (NC Medicaid-3085) Forms via upload.
Omadacycline for Injection, for Intravenous Use (Nuzyra™) HCPCS code J3490 - Unclassified drugs: Billing Guidelines
Nuzyra is available as 100 mg of omadacycline (equivalent to 131 mg omadacycline tosylate) as a lyophilized powder in a single dose vial for reconstitution and further dilution before intravenous infusion.
Remittance Statement of Adjustment for Third Party Recovery
The State and GDIT are in the process of completing NCTracks system updates to provide notification on the Remittance Statement of adjustment actions taken on previously paid claims due to audits conducted by Third Party Recovery and the Office of Compliance and Program Integrity.
Posting “Notice of Your Rights Under Hawkins v. Cohen”
Please post an English and Spanish version of the “Notice Of Your Rights Under Hawkins v. Cohen” in a prominent location for at least 180 calendar days.
NC Medicaid-3051 Form Submission
Effective May 1, 2019, beneficiaries requesting Personal Care Services must use the updated NC Medicaid-3051 Request for Independent Assessment for Personal Care Services Attestation of Medical Need Form. This form is a revision of the currently used NC Medicaid-3051 Form. The current form will be accepted by the Independent Assessment Entity through July 1, 2019.
Billing Code Update (February 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
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
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)
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.
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