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2010 Medicaid Bulletin Index

Medicaid bulletin articles and special bulletins organized by provider type for 2010.

All Providers:

• 2010 Census, 3/10
• 2011 Checkwrite Schedule:
  • 10/10
  • 11/10
• Adjusting North Carolina Medicaid Claims Electronically, 2/10
• Amendment Approval to the Family Planning Waiver, 3/10
• Basic Medicaid Seminars:
  • 2/10
  • 3/10
  • 8/10
  • 9/10
• Change of Ownership, 12/10
• Change in Implementation Date for Revised Coverage Criteria for Breast Surgeries, 11/10
• Changes to the EOB Code Crosswalk to HIPAA Standard Codes:
  • 7/10
  • 12/10
• Changes to the N.C. Medicaid Preferred Drug List, 8/10
• Clarification of Bariatric Surgery Requirements, 9/10
• Clarification on Procedures for Reviewing Prior Approval Requests and for Obtaining Additional Information, 1/10
• Clarification on the Provider Enrollment Fee, 3/10
• Clinical Coverage Policies:
  • 3/10
  • 4/10
  • 6/10
  • 8/10
  • 9/10
  • 10/10
  • 12/10
• Coming Soon: Remittance and Status Reports in PDF Format, 4/10
• Contact E-Mail Addresses, 11/10
• Copayment Changes, 10/10
• Copayments and Copayment Exemptions, 1/10
• Corrected 1099 Requests for Tax Years 2007, 2008, and 2009: Action Required by March 1, 2010, 1/10
• Coverage of Prescription Vitamin and Mineral Products, 8/10
• CPT Code 99420, 6/10
• CPT Code Update 2010, 1/10
• CPT Codes 64490, 64491, 64492, 64493, 64494, and 64495, 4/10
• CPT Procedure 29828 and Modifier 51, 10/10
• CPT Procedure Code 93351, 12/10
• CPT Procedure Codes 34812 and 34820 with Modifier 50, 2/10
• Critical Access Behavioral Health Agencies:
  • 5/10
  • 6/10
• Denials of CPT Procedure Codes 93320, 93321, and 93325, 2/10
• Denials with CPT Procedure Code 72295, 2/10
• Diagnosis Codes V18.11 and V18.19, 11/10
• DMA Prior Approval Information Web Page, 4/10
• Electronic Claim Submission EOB Code, 1/10
• Electronic Funds Transfer, 1/10
• Elimination of Coverage for Bariatric Surgery, 8/10
• End-Dated Coverage of Panniculectomy, 8/10
• End-Dated Coverage of Panniculectomy:  Correction to Procedure Code, 9/10
• Enrollment Fee Update:
  • 9/10
  • Reminders, 10/10
  • Reminders, 12/10
• Enrollment of Medicare/Medicaid Recipients into Community Care of North Carolina/Carolina ACCESS, 4/10
• False Claim Act Education Compliance for Federal Fiscal Year 2009:
  • 10/10
  • 12/10
• Family Planning Waiver Update, 9/10
• Flu Testing: CPT Code 87804, 4/10
• HCPCS Code Changes for the Physician's Drug Program, 3/10
• Health Check/EPSDT Billing Guide, 12/10
• Health Check/EPSDT Seminars:
  • 3/10
  • 4/10
• Helpful Hints to Ensure a Provdier Enrollment Application is Processed Without Delay, 4/10
• HP Enterprise Services Address Change, 2/10
• HP Mailing Address Changes, 4/10
• Human Papilloma Virus (HPV) Vaccine, Quadrivalent (CPT Code 90649, Gardasil): Additional Coverage Guidelines, 3/10
• Human Papilloma Virus (HPV) Vaccine, Types 16, 18, Bivalent, 3-Dose Schedule for Intranuscular Use (Cervarix, CPT Codes 90650): Billing Guidelines, 8/10
• Implementation of a Recipient Management Lock-in Program, 8/10
• Implementation of the National Correct Coding Initiative:
  • 10/10
  • 12/10
• Important Safety Information on Valproate, 7/10
• Incomplete Application Final Notice, 11/10
• Incomplete Provider Enrollment Applications, 7/10
• Influenza Vaccine and Reimbursement Guidelines for 2010/2011, 10/10
• Maintaining the Security and Accessibility of Records afater a Provider Agency Closes, 6/10
• Maternal Outreach Worker Program, 8/10
• Medicaid Credit Balance Reporting:
  • 3/10
  • 6/10
  • 9/10
• Medicaid Integrity Contractors Audit:
  • 5/10
  • 6/10
  • 7/10
  • 8/10
  • 9/10
  • 10/10
• Medicaid Integrity Contractors Audit: Updated Information Effective October 1, 2010:
  • 11/10
  • 12/10
• Medicaid Provider Administrative Participation Agreement:
  • 7/10
  • Update, 8/10
• Medicaid Provider Payment Suspension, 4/10
• Medicaid Recipient Appeal Process and Early and Periodic Screening, Diagnosis, and Treatment Seminars:
  • 1/10
  • 12/10
• Medicaid Reimbursement Rate Update, 9/10
• Medicare and Medicaid Health Information Technology: Title IV of the American Recovery and Reinvestment Act:
  • 1/10
  • 9/10
  • 10/10
  • 11/10
• MedSolutions’ Commitment to Assuring a Collaborative, Successful Ultrasound Management Program in North Carolina, 5/10
• New Option for Submitting Recipient Commercial Insurance Information Updates, 4/10
• NC Mental Health, Developmental Disabilities, and Substance Abuse Services Health Plan Waiver (Formerly, Piedmont Cardinal Health Plan):
  • 6/10
  • 12/10
• NC Tracks Website Maintenance, 6/10
• North Carolina Electronic Claim Submission and Electronic Initiatives Seminars, 1/10
• North Carolina Electronic Claims Submission/Recipient Eligibility Verification Web Tool, 1/10
• North Carolina Electronic Claims Submission/Recipient Elgibility Verification Web Tool: Medicare Indicators, 4/10
• North Carolina Medicaid's Use of CPT Consultation Codes, 2/10
• North Carolina Medicaid Preferred Drug List:
  • 3/10
  • 4/10
• Optical Character Recognition for Paper Claims
  • 7/10
  • 10/10
• Outpatient Specialized Therapies: Documentation Standards, 12/10
• Paper Claim Submissions, 1/10
• Password Changes for the North Carolina Electronic Claims Submission Web Tool, 4/10
• Payment Error Rate Measurement in North Carolina:
  • 5/10
  • 6/10
  • 7/10
  • 8/10
  • 9/10
  • 10/10
  • 11/10
  • 12/10
• PDF Format Remittance and Status Reports Changes, 6/10
• PDF Format Remittance and Status Reports Changes Implemented, 7/10
• Pneumococcal Conjugate Vaccine, 13 Valent, (PCV13) for Intramuscular Use (Prevnar, 13, CPT Code 90670): Coverage Guidelines, 5/10
• Policy Changes for Coverage of Breast Surgeries, 8/10
• Pregnancy Medical Home Project:
  • 10/10
  • 12/10
• Prior Approval for Bariatric Surgery, 12/10
• Prior Approval for Imaging Procedure Policy and Update for Lesser Intensity Procedures, 11/10
• Prior Authorization for Non-emergency High-tech Outpatient Radiology and Ultrasound Procedures: Updates, 2/10
• Procedures for Prescribing Synagis for RSV Season 2010/2011, 10/10
• Program Integrity Prepayment Claims Review, 2/10
• Prosecution for Fraudulent Activity, 9/10
• Provider Enrollment Application Process, 10/10
• Provider Information Regarding Changes in N.C. Health Choice Administration:
  • 6/10
  • 7/10
• Provider Information Regarding Changes in N.C. Health Choice Copayments:
  • 6/10
  • 7/10
• Recipient Notifications, 9/10
• Reductions to Covered Podiatry Services:
  • 8/10
  • 10/10
• Reimbursement for the Duplication of Medical Records, 5/10
• Remittance and Status Reports in PDF Format, 5/10
• Reporting Fraud, Waste, and Program Abuse:
  • 4/10
  • 6/10
• Resolution of the Shorage of Haemophilus Influenzae Type B (Hib) Vaccine and Clarifications Regarding Hib Vaccines, 8/10
• Requirement for Internal Claim Number on Self-Audits, 10/10
• Risperdone, Long Acting, 0.5 mg (Risperdal Consta, HCPCS Code J2794: Additional Coverage Guidelines, 4/10
• State Medicaid Health Information Technology Plan, 7/10
• The N.C. Health Insurance Premium Payment Program, 11/10
• Top EOB Codes for Claims Denials, 7/10
• UD Modifier and 340B Purchased Drugs, 7/10
• Unauthorized Use of a Community Care of NC/Carolina ACCESS Provider's NPI Number Is Considered Medicaid Program Abuse, 10/10
• Upcoming Change to EOB Crosswalk to HIPAA Standard Codes, 6/10
• Update on the N.C. Health Information Technology Plan and Schedule, 12/10
• Update to the Annual Medicaid Identification Card, 8/10
• Updated EOB Code Crosswalk to HIPAA Standard Codes:
  • 1/10
  • 4/10
• Urine Drug Screening:
  • 9/10
  • 11/10
• Who’s Who in North Carolina Medicaid, 1/10

Adult Care Home Providers:

• Adult Care Home Prior Approval and Admissions, 8/10
• Clarification of Suspension of Mandatory Cost Reporting for Rate Adjustments, 4/10
• Items Billed to Medicaid on Behalf of Residents, 1/10
• N.C. Medicaid Applies to CMS for Services Authorized Under 1915(I) Adult Care Home Residents, 11/10
• Suspension of Mandatory Cost Reporting for Rate Adjustments, 3/10

Ambulatory Surgical Centers:

• CPT Procedure Codes 64490, 64491, 64492, 64493, 64494, and 64495, 8/10
• Reimbursement Rate Update, 1/10

Anesthesia Providers:

• Anesthesia Policy Clarification, 6/10

Case Management Providers:

• Limits for Medicaid Case Management Services, 1/10
• Policy Changes for Case Management Services:
  • 2/10
  • Correction to Article, 2/2/10
  • 3/10

Certified Registered Nurse Anesthetists:

• Anesthesia Policy Clarification, 6/10

Children's Developmental Services Agencies:

• Community Based Rehabilitative Services:
  • 1/10
  • Update, 3/10
  • Update, 5/10
  • Update, 7/10
• Outpatient Specialized Therapies: Documentation Standards, 12/10
• Outpatient Specialized Therapies Prior Authorization Process: Post-Payment Validation, 4/10
• Outpatient Specialized Therapies: Prior Authorization and Post-Payment Validation, 3/10
• Policy Changes for Case Management Services:
  • 2/10
  • Correction to Article, 2/2/10
  • 3/10
• Post-Payment Validation Review “Helpful Hints”, 9/10

Community Alternatives Program Case Managers:

• Additions to the Home Health Medical Supply Fee Schedule, 4/10
• New Enrollment for Durable Medical Equipment Suppliers for Community Alternatives Program Waiver Supplies, 5/10
• Policy Changes for Case Management Services:
  • 2/10
  • Correction to Article, 2/2/10
  • 3/10
• Update to Coding on Home Health Fee Schedule, 1/10
• Video Conference Seminars for Providers of Durable Medical Equipment and Orthotics and Prosthetics:
  • 6/10
  • 7/10

CAP/C Case Managers:

• CAP/C Waiver Renewal, 9/10
• CAP/C Waiver Renewal Training, 8/10
• New Rate for Split of Services for Private Duty Nursing and CAP/C Nursing Services and Congregate Nursing Code, 11/10
• Video Conference Seminars for CAP/C Case Managers and CAP/C Providers, 12/10

CAP/C Service Providers:

• CAP/C Waiver Renewal, 9/10
• Medical Supplies Provision for Recipients Approved for Private Duty Nursing Services, 4/10
• New Rate for Split of Services for Private Duty Nursing and CAP/C Nursing Services and Congregate Nursing Code, 11/10
• Video Conference Seminars for CAP/C Case Managers and CAP/C Providers, 12/10

CAP/MR-DD Service Providers:

• Adverse Determination Notification Changes, 11/10
• Changes in Utilization Review Vendor for CAP/MR-DD Utilization, 11/10
• Clarification of Suspension of Mandatory Cost Reporting for Rate Adjustments, 4/10
• Next Medicaid Managed Care Vendor Selected, 11/10
• Suspension of Mandatory Cost Reporting for Rate Adjustments, 3/10
• Utilization Review for CAP/MR-DD, 12/10

Community Care of NC/Carolina ACCESS Primary Care Providers:

• Addition of Pen Needles to Pharmacy Point of Sale, 3/10
• Carolina ACCESS Provider Management Reports, 9/10
• Recipient Enrollment by Primary Care Providers, 7/10

Critical Access Behavioral Health Agencies:

• Adverse Determination Notification Changes, 11/10
• Application Clarifications, 8/10
• Community Support Case Management Component, 6/10
• Critical Access Behavioral Health Agency Benchmarks and Transition Planning, 11/10
• Critical Access Behavioral Health Agencies:
  • 5/10
  • 6/10
• Enrollment, Authorization, and Billing Frequently Asked Questions, 10/10
• Enrollment/Authorization/Billing Seminars for Critical Access Behavioral Health Agencies, 8/10
• Extension of Case Management Functions of Community Support Services, 8/10
• Next Medicaid Managed Care Vendor Selected, 11/10
• Peer Support Services Status, 12/10
• Performance Bonds, 12/10
• Prior Authorization and Billing for Community Support Team, 9/10
• Prior Authorization and Billing for Mental Health/Substance Abuse Targeted Case Management, 10/10
• Prior Authorization of Medicaid-Funded Mental Health,Developmental Disability, and Substance Abuse Services by The Durham Center and Eastpointe LME, 9/10
• Prior Authorization of Medicaid-Funded Mental Health, Developmental Disabilities, and Substance Abuse Services for Recipients with Eligibility in Durham, Duplin, Lenoir, Sampson, and Wayne Counties, 8/10
• Reminder about Authorizations for Community Support Team, Intensive In-Home, Day Treatment, and Community Support Services for Providers Who Have Not Achieved CABHA Status, 11/10
• Service Orders for Mental Health/Substance Abuse Targeted Case Management, 11/10
• Top Reasons that Could Cause an Interruption in Payment, 9/10
• Transition Timeframe for Full Critical Access Behavioral Health Agency Implementation, 8/10
• Update on Mental Health/Substance Abuse Targeted Case Management, 9/10
• Update on New Prior Authorization Guidelines for Behavioral Health Services, 8/10
• Update on Unmanaged Visits for Children, 10/10
• ValueOptions ProviderConnect Reminders, 11/10

Dental Providers:

• Dental Program Changes Included in the 2010 Budget Bill, 11/10

Durable Medical Equipment Providers:

• Addition of Pen Needles to Pharmacy Point of Sale, 3/10
• Additional Information on Prodigy Diabetic Supplies:
  • 1/10
  • 3/10
  • 5/10
• Changes to HCPCS Codes A4253, A4259, and S8490, 7/10
• Items Billed to Medicaid on Behalf of Residents, 1/10
• Medically Necessary Incontinence, Ostomy, and Urological Supplies:
  • 3/10
  • Update, 3/1/10
• New Enrollment for Durable Medical Equipment Suppliers for Community Alternatives Program Waiver Supplies, 5/10
• Rate Adjustments for Selected HCPCS Codes, 5/10
• Rates for Codes B4100, B4103, B4104, and S8265, 5/10
• Video Conference Seminars for Providers of Durable Medical Equipment and Orthotics and Prosthetics:
  • 6/10
  • 7/10

Early Intervention Services Providers:

• Community Based Rehabilitative Services:
  • 1/10
  • Update, 3/10
  • Update, 5/10
  • Update, 7/10
• Policy Changes for Case Management Services:
  • 2/10
  • Correction to Article, 2/2/10
  • 3/10

Enhanced Behavioral Health (Community Intervention) Services Providers:

• Adverse Determination Notification Changes, 11/10
• Clarification of Suspension of Mandatory Cost Reporting for Rate Adjustments, 4/10
• Community Support Authorizations, 11/10
• Community Support Case Management Component, 6/10
• Community Support Team Services Revised Effective Date and Rate, 7/10
• Critical Access Behavioral Health Agency Benchmarks and Transition Planning, 11/10
• DHHS/DMA Program Integrity Contract with Public Consulting Group, 4/10
• Enhanced Services Policy Updates, 3/10
• Extension of Case Management Functions of Community Support Services, 8/10
• Next Medicaid Managed Care Vendor Selected, 11/10
• Prior Authorization and Billing for Community Support Team, 9/10
• Prior Authorization of Medicaid-Funded Mental Health,Developmental Disability, and Substance Abuse Services by The Durham Center and Eastpointe LME, 9/10
• Prior Authorization of Medicaid-Funded Mental Health, Developmental Disabilities, and Substance Abuse Services for Recipients with Eligibility in Durham, Duplin, Lenoir, Sampson, and Wayne Counties, 8/10
• Reminder about Authorizations for Community Support Team, Intensive In-Home, Day Treatment, and Community Support Services for Providers Who Have Not Achieved CABHA Status, 11/10
• Suspension of Mandatory Cost Reporting for Rate Adjustments, 3/10
• ValueOptions ProviderConnect Reminders, 11/10

Federally Qualified Health Centers:

• HCPCS Procedure Code T1015 and Modifier HI, 1/10

Health Department Dental Centers:

• Dental Program Changes Included in the 2010 Budget Bill, 11/10

Health Departments:

• Outpatient Specialized Therapies: Documentation Standards, 12/10
• Outpatient Specialized Therapies Prior Authorization Process: Post-Payment Validation, 4/10
• Outpatient Specialized Therapies: Prior Authorization and Post-Payment Validation, 3/10
• Post-Payment Validation Review “Helpful Hints”, 9/10

HIV Case Management Providers:

• Announcement of New Vendor for HIV Case Management Program, 8/10
• HIV Case Management Provider Training Sessions:
  • 10/10
  • 12/10
• Implementation of HIV Case Management Policy, 9/10
• Procedure Code Change for HIV Case Management, 8/10
• Reminders and Updates for HIV Case Management Services, 11/10
• Transfer of HIV Case Management Operations, 4/10

Home Health Agencies:

• Additions to the Home Health Medical Supply Fee Schedule, 4/10
• Items Billed to Medicaid on Behalf of Residents, 1/10
• Medical Supplies Provision for Recipients Approved for Private Duty Nursing Services, 4/10
• Outpatient Specialized Therapies: Documentation Standards, 12/10
• Outpatient Specialized Therapies Prior Authorization Process: Post-Payment Validation, 4/10
• Outpatient Specialized Therapies: Prior Authorization and Post-Payment Validation, 3/10
• Post-Payment Validation Review “Helpful Hints”, 9/10
• Update to Coding on Home Health Fee Schedule, 1/10

Hospice Services:

• CAP/C Waiver Renewal, 9/10

Hospital Outpatient Clinics:

• Outpatient Specialized Therapies: Documentation Standards, 12/10
• Outpatient Specialized Therapies Prior Authorization Process: Post-Payment Validation, 4/10
• Outpatient Specialized Therapies: Prior Authorization and Post-Payment Validation, 3/10
• Outpatient Specialized Therapies Video Conference Seminars:
  • 2/10
  • 3/10
• Post-Payment Validation Review “Helpful Hints”, 9/10

Hospitals:

• Grouper 26 Implementation, 1/10

Independent Laboratories:

• Flu Testing: CPT Code 87804, 4/10
• Urine Drug Screening, 9/10

Independent Practitioners:

• Code Addition, 1/10
• Outpatient Specialized Therapies: Documentation Standards, 12/10
• Outpatient Specialized Therapies Prior Authorization Process: Post-Payment Validation, 4/10
• Outpatient Specialized Therapies: Prior Authorization and Post-Payment Validation, 3/10
• Outpatient Specialized Therapies Video Conference Seminars:
  • 2/10
  • 3/10
• Post-Payment Validation Review “Helpful Hints”, 9/10
• Posting of Respiratory Therapy Services Policy, 5/10

Inpatient Behavioral Health Services:

• Adverse Determination Notification Changes, 11/10
• DHHS/DMA Program Integrity Contract with Public Consulting Group, 4/10
• Next Medicaid Managed Care Vendor Selected, 11/10
• Prior Authorization of Medicaid-Funded Mental Health,Developmental Disability, and Substance Abuse Services by The Durham Center and Eastpointe LME, 9/10
• Prior Authorization of Medicaid-Funded Mental Health, Developmental Disabilities, and Substance Abuse Services for Recipients with Eligibility in Durham, Duplin, Lenoir, Sampson, and Wayne Counties, 8/10

Institutional (UB-04/837I) Billers:

• Medicare Health Maintenance Organization: Institutional Services, 5/10
• Non-Monetary Value Codes, 10/10

Intermediate Care Facilities for Individuals with
Mental Retardation:

• ICF/MR Provider Assessment Fee Decrease, 7/10
• ICF/MR Provider Assessment Fee Increase, 1/10

Local Education Agencies:

• Code Addition, 1/10
• Outpatient Specialized Therapies: Documentation Standards, 12/10
• Outpatient Specialized Therapies Prior Authorization Process: Post-Payment Validation, 4/10
• Outpatient Specialized Therapies: Prior Authorization and Post-Payment Validation, 3/10
• Post-Payment Validation Review “Helpful Hints”, 9/10

Local Management Entities:

• Changes in Utilization Review Vendor for CAP/MR-DD Utilization, 11/10
• Community Support Authorizations, 11/10
• Community Support Case Management Component, 6/10
• Critical Access Behavioral Health Agency Benchmarks and Transition Planning, 11/10
• DHHS/DMA Program Integrity Contract with Public Consulting Group, 4/10
• Enhanced Services Policy Updates, 3/10
• Extension of Coverage for Provisionally Licensed Providers Billing Outpatient Behavioral Health Services through the Local Management Entity:
  • 3/10
  • 4/10
• Injectable Drugs:  Update to Billing Guidelines, 10/10
• New Prior Authorization Guidelines, 6/10
• Next Medicaid Managed Care Vendor Selected, 11/10
• Olanzapine Injectable (Zyprexa Relprevv, HCPCS Code J3490, and Zyprexa, HCPCS Code S0166): Billing Guidelines, 5/10
• Outpatient Specialized Therapies: Documentation Standards, 12/10
• Outpatient Specialized Therapies Prior Authorization Process: Post-Payment Validation, 4/10
• Outpatient Specialized Therapies: Prior Authorization and Post-Payment Validation, 3/10
• Peer Support Services Status, 12/10
• Post-Payment Validation Review “Helpful Hints”, 9/10
• Prior Authorization of Medicaid-Funded Mental Health,Developmental Disability, and Substance Abuse Services by The Durham Center and Eastpointe LME, 9/10
• Prior Authorization of Medicaid-Funded Mental Health, Developmental Disabilities, and Substance Abuse Services for Recipients with Eligibility in Durham, Duplin, Lenoir, Sampson, and Wayne Counties, 8/10
• Update on New Prior Authorization Guidelines for Behavioral Health Services, 8/10
• Utilization Review for CAP/MR-DD, 12/10

N.C. Health Choice Providers:

• N.C. Health Choice Non-Covered Policies, 12/10
• N.C. Health Choice Review Process, 11/10
• Provider Information Regarding Changes in N.C. Health Choice Administration, 6/10
• Provider Information Regarding Changes in N.C. Health Choice Copayments, 6/10

Nurse Practitioners:

• Adult Care Home Prior Approval and Admissions, 8/10
• Apoetin Alfa (Epogen/Procitr, HCPCS Code J0885) and Darbepoetin Alfa (Aranesp, HCPCS Code J0881) for Non-ESRD Use:  New Billing Guidelines, 1/10
• Bevacizumab (Avastin, HCPCS Code J9035): Update to Billing Guidelines, 5/10
• C1 Esterase Inhibitor (Human) 10 units (Cinryze, Berinert HCPCS Code J0598):  Billing Guidelines, 2/10
• C1 Esterase Inhibitor (Human) Injectable, 10 Units (Berinert, HCPCS Code J3590): Revised Billing Guidelines, 4/10
• C1 Esterase Inhibitor (Human) Injectable, 10 Units (Cinryze, HCPCS Code J0598): Revised Billing Guidelines, 4/10
• Cabazitaxel Injection (Jevtana, HCPCS Code J9999):  Billing Guidelines, 10/10
• Coagulation Factor VIII Complex/von Willebrand Factor (Human) (Wilate, HCPCS Code J3590): Billing Guidelines, 5.10
• CPT Codes 57452, 57454, and 57505, 4/10
• Denosumab Injection (Prolia, HCPCS Code J3590):  Billing Guidelines, 9/10
• Dexamethasone Implant, Intraviteral (Ozurdex, HCPCS Code J3490): Billing Guidelines, 2/10
• Ecallantide Injectable (Kalbitor, HCPCS Code J3490): Billing Guidelines, 5/10
• Epoetin Alfa (Epogen/Procrit, HCPCS Code J0885) and Darbepoetin Alfa (Aranesp, HCPCS Code J0881): New Billing Guidelines, 12/10
• Fondaparinux Sodium Injectable 0.5 mg (Arixtra, HCPCS Code J1652):  Billing Guidelines, 2/10
• Immune Globulin Subcutaneous (Human) Injectable (Hizentra, HCPCS Code J3590): Billing Guidelines, 6/10
• Injectable Drugs:  Update to Billing Guidelines, 10/10
• Interferon Beta-1b Injectable (Extavia, HCPCS Code J1830): Billing Guidelines, 2/10
• Ofatumumab Injectable (Arzerra, HCPCS Code J9999):  Billing Guidelines, 2/10
• Olanzapine Injectable (Zyprexa Relprevv, HCPCS Code J3490, and Zyprexa, HCPCS Code S0166): Billing Guidelines, 5/10
• Pralatrexate Injectable (Folotyn, HCPCS Code J9999):  Billing Guidelines, 2/10
• Ranibizumab (Lucentis, HCPCS Code J2778):  Update to Billing Guidelines, 10/10
• Rilonacept (Arcalyst, HCPCS Code J2793):  Billing Guidelines, 2/10
• Sildenafil Injectable (Revation, HCPCS Code J3490): Billing Guidelines, 5/10
• Telavancin Injectable (Vibativ, HCPCS Code J3490):  Billing Guidelines, 2/10
• Tocilizumab Injectable (Actemra, HCPCS Code J3590): Billing Guidelines, 5/10
• Ustekinumab Injectable (Stelara, HCPCS Code J3590): Billing Guidelines, 2/10
• Velaglucerase Alfa Injectable (VPRIV, HCPCS Code J3590): Billing Guidelines, 6/10
• Zoledronic Acid (Reclast, HCPCS Code J3488):  Update to Billing Guidelines, 10/10

Nursing Facilities:

• MDS Validation and Case Mix Documentation Review Policies for Onsite Reviews, 11/10
• Minimum Data Set 3.0 Validation Program Seminars, 8/10
• North Carolina Referral Process for MDS 3.0 Section Q, 10/10
• Nursing Facility Provider Assessment Fee Increase, 1/10

OB/GYN Providers:

• Proposed Obstetrical Ultrasound Requirements, 8/10
• Updates to Prior Authorization for Obstetrical Ultrasounds, 10/10

Orthotics and Prosthetics Providers:

• 2010 HCPCS Code Changes for Orthotics and Prosthetics, 2/10
• Changes to HCPCS Code S1040, 9/10
• Coverage of Prosthetic Components, 11/10
• Video Conference Seminars for Providers of Durable Medical Equipment and Orthotics and Prosthetics:
  • 6/10
  • 7/10

Outpatient Behavioral Health Providers:

• Adverse Determination Notification Changes, 11/10
• DHHS/DMA Program Integrity Contract with Public Consulting Group, 4/10
• Extension of Coverage for Provisionally Licensed Providers Billing Outpatient Behavioral Health Services through the Local Management Entity:
  • 3/10
  • 4/10
• New Prior Authorization Guidelines, 6/10
• Next Medicaid Managed Care Vendor Selected, 11/10
• Prior Authorization of Medicaid-Funded Mental Health,Developmental Disability, and Substance Abuse Services by The Durham Center and Eastpointe LME, 9/10
• Prior Authorization of Medicaid-Funded Mental Health, Developmental Disabilities, and Substance Abuse Services for Recipients with Eligibility in Durham, Duplin, Lenoir, Sampson, and Wayne Counties, 8/10
• Update on New Prior Authorization Guidelines for Behavioral Health Services, 8/10
• Update on Unmanaged Visits for Children, 10/10
• ValueOptions ProviderConnect Reminders, 11/10

Personal Care Services Providers:

• Clarification of Suspension of Mandatory Cost Reporting for Rate Adjustments, 4/10
• Implementation of Independent Assessment, Prior Authorization, and New Personal Care Services and PCS-Plus Clinical Coverage Policy,
  • 4/10
  • 5/10
• Implementation of PCS PACT Reviews and Independent Assessments:
  • 1/10
  • 2/10
  • 3/10
• Independent Assessment Reminders:
  • 6/10
  • 7/10
  • 8/10
  • 9/10
  • 10/10
  • 11/10
  • 12/10
• Suspension of Mandatory Cost Reporting for Rate Adjustments, 3/10

Pharmacists:

• Addition of Pen Needles to Pharmacy Point of Sale, 3/10
• Additional Information on Prodigy Diabetic Supplies:
  • 1/10
  • 3/10
  • 5/10
• Changes to HCPCS Codes A4253, A4259, and S8490, 7/10
• Coverage of Over-the-Counter Second Generation Antihistamine and Decongestant Combinations, 9/10
• Discontinuation of Focused Risk Management Program, 12/10
• End-Dated Coverage for Exocrine Pancreatic Insufficiency Drugs, 6/10
• End-Dated Coverage of Generic Colchicine, 12/10
• Lost Prescriptions Limited to One Occurrence During a 365-Day Time Period, 8/10
• N.C. Medicaid Preferred Drug List Changes, 6/10
• New Prior Authorization Requirements for Brand-Name Anticonvulsants, 1/10
• New Prior Authorization Requirements for Topical Anti-inflammatory Medications, 1/10
• Point-of-Sale Overrides for Leukotrienes, Statins, Orally Inhaled Steroids, and Second Generation Anticonvulsants, 9/10
• Policies for Emend, Leukotrienes, Lidodrem, Orally Inhaled Corticosteroids, Statins, and Suboxone and Revised Policies for CII Narcotic Analgesics and Second Generation Anticonvulsants, 9/10
• Prior Authorization Requirements for Fibrates and Lovaza:  Clarification, 1/10
• Recipient Management Lock-in Program Emergency Fill, 10/10
• Removal of Active Pharmaceutical Ingredients and Excipients as Covered Outpatient Drugs, 12/10
• Substitution for Duoneb and Insulin Cartridges and Pens, 9/10
• Substitution of Preferred Brand Drugs, 9/10
• Synagis Pharmacy Claims for 2009/2010 Season, 6/10

Physicians:

• Adult Care Home Prior Approval and Admissions, 8/10
• Apoetin Alfa (Epogen/Procrit, HCPCS Code J0885) and Darbepoetin Alfa (Aranesp, HCPCS Code J0881) for Non-ESRD Use:  New Billing Guidelines, 1/10
• Bevacizumab (Avastin, HCPCS Code J9035): Update to Billing Guidelines, 5/10
• C1 Esterase Inhibitor (Human) 10 units (Cinryze, Berinert HCPCS Code J0598):  Billing Guidelines, 2/10
• C1 Esterase Inhibitor (Human) Injectable, 10 Units (Berinert, HCPCS Code J3590): Revised Billing Guidelines, 4/10
• C1 Esterase Inhibitor (Human) Injectable, 10 Units (Cinryze, HCPCS Code J0598): Revised Billing Guidelines, 4/10
• Cabazitaxel Injection (Jevtana, HCPCS Code J9999):  Billing Guidelines, 10/10
• Coagulation Factor VIII Complex/von Willebrand Factor (Human) (Wilate, HCPCS Code J3590): Billing Guidelines, 5/10
• Collagenase Clostridium Histolyticum Injectable (Xiaflex, HCPCS Code J3590): Billing Guidelines, 5/10
• Denosumab Injection (Prolia, HCPCS Code J3590):  Billing Guidelines, 9/10
• Dexamethasone Implant, Intraviteral (Ozurdex, HCPCS Code J3490): Billing Guidelines, 2/10
• Ecallantide Injectable (Kalbitor, HCPCS Code J3490): Billing Guidelines, 5/10
• Epoetin Alfa (Epogen/Procrit, HCPCS Code J0885) and Darbepoetin Alfa (Aranesp, HCPCS Code J0881): New Billing Guidelines, 12/10
• Fondaparinux Sodium Injectable 0.5 mg (Arixtra, HCPCS Code J1652):  Billing Guidelines, 2/10
• Immune Globulin Subcutaneous (Human) Injectable (Hizentra, HCPCS Code J3590): Billing Guidelines, 6/10
• Interferon Beta-1b Injectable (Extavia, HCPCS Code J1830): Billing Guidelines, 2/10
• Ofatumumab Injectable (Arzerra, HCPCS Code J9999):  Billing Guidelines, 2/10
• Olanzapine Injectable (Zyprexa Relprevv, HCPCS Code J3490, and Zyprexa, HCPCS Code S0166): Billing Guidelines, 5/10
• Outpatient Specialized Therapies: Documentation Standards, 12/10
• Outpatient Specialized Therapies Prior Authorization Process: Post-Payment Validation, 4/10
• Outpatient Specialized Therapies: Prior Authorization and Post-Payment Validation, 3/10
• Outpatient Specialized Therapies Video Conference Seminars:
  • 2/10
  • 3/10
• Post-Payment Validation, 4/10
• Post-Payment Validation Review “Helpful Hints”, 9/10
• Pralatrexate Injectable (Folotyn, HCPCS Code J9999):  Billing Guidelines, 2/10
• Proposed Obstetrical Ultrasound Requirements, 8/10
• Ranibizumab (Lucentis, HCPCS Code J2778):  Update to Billing Guidelines, 10/10
• Rilonacept (Arcalyst, HCPCS Code J2793):  Billing Guidelines, 2/10
• Sildenafil Injectable (Revation, HCPCS Code J3490): Billing Guidelines, 5/10
• Telavancin Injectable (Vibativ, HCPCS Code J3490):  Billing Guidelines, 2/10
• Tocilizumab Injectable (Actemra, HCPCS Code J3590): Billing Guidelines, 5/10
• Ustekinumab Injectable (Stelara, HCPCS Code J3590): Billing Guidelines, 2/10
• Velaglucerase Alfa Injectable (VPRIV, HCPCS Code J3590): Billing Guidelines, 6/10
• Zoledronic Acid (Reclast, HCPCS Code J3488):  Update to Billing Guidelines, 10/10

Podiatry Services:

• Reductions to Covered Podiatry Services, 8/10

Prescribers:

• Coverage of Over-the-Counter Second Generation Antihistamine and Decongestant Combinations, 9/10
• Discontinuation of Focused Risk Management Program, 12/10
• End-Dated Coverage for Exocrine Pancreatic Insufficiency Drugs, 6/10
• End-Dated Coverage of Generic Colchicine, 12/10
• N.C. Medicaid Preferred Drug List Changes, 6/10
• New Prior Authorization Requirements for Brand-Name Anticonvulsants, 1/10
• New Prior Authorization Requirements for Topical Anti-inflammatory Medications, 1/10
• Policies for Emend, Leukotrienes, Lidodrem, Orally Inhaled Corticosteroids, Statins, and Suboxone and Revised Policies for CII Narcotic Analgesics and Second Generation Anticonvulsants, 9/10
• Prior Authorization Requirements for Fibrates and Lovaza:  Clarification, 1/10
• Removal of Active Pharmaceutical Ingredients and Excipients as Covered OUtpatient Drugs, 12/10
• Substitution for Duoneb and Insulin Cartridges and Pens, 9/10
• Substitution of Preferred Brand Drugs, 9/10

Private Duty Nursing Providers:

• Code Changes for Hourly Nursing Services, 9/10
• New Rate for Split of Services for Private Duty Nursing and CAP/C Nursing Services and Congregate Nursing Code, 11/10

Professional (CMS-1500/837P) Billers:

• Medicare Health Maintenance Organization: Professional Services, 5/10

Psychiatric Hospitals:

• Adverse Determination Notification Changes, 11/10
• Next Medicaid Managed Care Vendor Selected, 11/10
• Prior Authorization of Medicaid-Funded Mental Health,Developmental Disability, and Substance Abuse Services by The Durham Center and Eastpointe LME, 9/10
• Prior Authorization of Medicaid-Funded Mental Health, Developmental Disabilities, and Substance Abuse Services for Recipients with Eligibility in Durham, Duplin, Lenoir, Sampson, and Wayne Counties, 8/10
• Updated Authorization Request Forms, 11/10

Psychiatric Residential Treatment Facilities:

• Adverse Determination Notification Changes, 11/10
• DHHS/DMA Program Integrity Contract with Public Consulting Group, 4/10
• Next Medicaid Managed Care Vendor Selected, 11/10
• Prior Authorization of Medicaid-Funded Mental Health,Developmental Disability, and Substance Abuse Services by The Durham Center and Eastpointe LME, 9/10
• Prior Authorization of Medicaid-Funded Mental Health, Developmental Disabilities, and Substance Abuse Services for Recipients with Eligibility in Durham, Duplin, Lenoir, Sampson, and Wayne Counties, 8/10
• Updated Authorization Request Forms, 11/10

Private Duty Nursing Providers:

• Additions to the Home Health Medical Supply Fee Schedule, 4/10
• Clarification of Suspension of Mandatory Cost Reporting for Rate Adjustments, 4/10
• Medical Supplies Provision for Recipients Approved for Private Duty Nursing Services, 4/10
• Update to Coding on Home Health Fee Schedule, 1/10

Radiology Services:

• CPT Procedure Code 77470, 11/10
• Proposed Obstetrical Ultrasound Requirements, 8/10
• Update to Radiation Therapy Treatment Delivery Procedure Codes (77371 through 77418), 12/10
• Updates to Prior Authorization for Obstetrical Ultrasounds, 10/10

Residential Child Care Treatment Facilities:

• Adverse Determination Notification Changes, 11/10
• Clarification of Suspension of Mandatory Cost Reporting for Rate Adjustments, 4/10
• Next Medicaid Managed Care Vendor Selected, 11/10
• Prior Authorization of Medicaid-Funded Mental Health,Developmental Disability, and Substance Abuse Services by The Durham Center and Eastpointe LME, 9/10
• Prior Authorization of Medicaid-Funded Mental Health, Developmental Disabilities, and Substance Abuse Services for Recipients with Eligibility in Durham, Duplin, Lenoir, Sampson, and Wayne Counties, 8/10
• Suspension of Mandatory Cost Reporting for Rate Adjustments, 3/10

Rural Health Clinics:

• HCPCS Procedure Code T1015 and Modifier HI, 1/10

TCM/IDD Case Managers:

• Adverse Determination Notification Changes, 11/10
• Implementation of New Procedure Code and Rate, 9/10
• Next Medicaid Managed Care Vendor Selected, 11/10
• Prior Authorization of Medicaid-Funded Mental Health,Developmental Disability, and Substance Abuse Services by The Durham Center and Eastpointe LME, 9/10
• Prior Authorization of Medicaid-Funded Mental Health, Developmental Disabilities, and Substance Abuse Services for Recipients with Eligibility in Durham, Duplin, Lenoir, Sampson, and Wayne Counties, 8/10
• Transition to Annual Authorization for Non-Waiver TCM/DD Services, 4/10
• ValueOptions ProviderConnect Reminders, 11/10