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Medicaid Bulletin

SPECIAL BULLETIN: Approved PHP Provider Contracts as of June 12, 2019

Wednesday, June 12, 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.

SPECIAL BULLETIN: Approved PHP Provider Contracts as of June 7, 2019

Monday, June 10, 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.

SPECIAL BULLETIN: Approved PHP Provider Contract Templates as of May 31, 2019

Tuesday, June 4, 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.

Gemcitabine in sodium chloride injection, for intravenous use (Infugem™) HCPCS code J9999: Billing Guidelines

Tuesday, June 4, 2019

Effective with date of service March 12, 2019, the North Carolina Medicaid and NC Health Choice programs cover gemcitabine in sodium chloride injection, for intravenous use (Infugem) for use in the Physician Administered Drug Program when billed with HCPCS code J9999 - not otherwise classified, antineoplastic drugs.

SPECIAL BULLETIN: Procedures Billable by Independent Diagnostic Testing Facilities (IDTF) Update

Tuesday, June 4, 2019

In the May 2019 Special Bulletin, Procedures Billable by Independent Diagnostic Testing Facilities (IDTF), NC Medicaid stated that coverage for 825 additional procedure codes for IDTFs would take effect June 1, 2019.

Are you in Compliance with NC Law? Connecting to NC’s Health Information Exchange, NC HealthConnex

Monday, June 3, 2019

One of the goals of a transformed health care system is for near real-time clinical and demographic data to be made available to all health care providers involved in a patient’s care so that they can securely share health information concerning that patient with each other.

North Carolina’s state-designated health information exchange, NC HealthConnex, was created in 2015 by the North Carolina General Assembly to help bridge the gap between disparate systems and health care networks to support whole patient care.

Esketamine nasal spray (Spravato™) HCPCS code J3490: Billing Guidelines

Monday, June 3, 2019

Effective with date of service 3/8/2019, the North Carolina Medicaid and NC Health Choice programs cover esketamine nasal spray (Spravato™) for use in the Physician Administered Drug Program when billed with HCPCS code J3490 - Unclassified drugs.

ICD 10 Codes for Acute Appendicitis

Monday, June 3, 2019

NC Medicaid has received calls concerning the ICD 10 diagnoses codes for acute appendicitis.

NC Medicaid has provided instructions to NCTracks on updating the diagnoses code list for acute appendicitis.

Clinical Coverage Policy (CCP) 1A-39 Routine Costs in Clinical Trial Services for Life Threatening Conditions

Monday, June 3, 2019

To align with children’s health quality measure reporting, NC Medicaid has added diagnosis code Z71.82 (Exercise Counseling) to NCTracks as an acceptable secondary diagnosis effective Oct. 1, 2017.

Rutherford County Transition Effective July 2019

Monday, June 3, 2019

The Secretary of the N.C. Department of Health and Human Services (DHHS) has approved the disengagement of Rutherford County from the VAYA Health Local Management Entity-Managed Care Organization (LME-MCO) and their alignment with Partners Behavioral Health Management LME-MCO.

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