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2011 Medicaid Bulletin Index

Medicaid bulletin articles and special bulletins organized by provider type for 2011.

All Providers:

 

• 2012 Checkwrite Schedule, 11/11
• Additional Correct Coding Edits, 5/11
• Add-on Code Denials, 6/11
• Affordable Care Act Implementation Updates, 6/11
• Amendment Approval to the Family Waiver,10/11
• Appendix A TPA - HIPAA 5010 Implementation, 12/11
• Audits and Post Payments Reviews, 10/11
• Basic Medicaid Seminars:
  • 2/11
  • 3/11
  • 4/11
  • 8/11
  • 9/11
• Bevacizumab (Avastin, HCPCS Procedure Code J9035) – Update to Billing Guidelines, 12/11
• Change in Cardiac Imaging Prior Approval Program Implementation Date, 10/11
• Change to CPT Code 17263, 11/11
• Change to Medicare Recovery Process, 7/11
• Changes in Medicaid Prior Approval Policies and Procedures, Recipient Due Process (Appeals), and Early Periodic Screening, Diagnosis and Treatment (EPSDT) Seminars:
  • 5/11
  • 6/11
• Changes in Medicaid Prior Approval and Recipient Due Process (Appeal Rights) Policies and Procedures, 5/11
• Changes to the N.C. Medicaid Preferred Drug List, 3/11
• Changes in Reimbursement for Immunization Administration, 6/11
• Checking the Status of an Application, 2/11
• Child Service Coordination Program and Maternity Care Coordination Program, 2/11
• Clinical Coverage Policies:
  • 1/11
  • 2/11
  • 3/11
  • 4/11
  • 5/11
  • 7/11
  • 9/11
  • 12/11
• Claims for CPT Code 49451 and Modifier 51, 5/11
• Corrected 1099 Requests for Tax Years 2008, 2009, and 2010:  Action Required by March 1, 2011, 1/11
• Correction to Carolina ACCESS Editing for Anesthesiology Services, 4/11
• Correction to CPT Update Bulletin Article, 5/11
• CPT Code 93351, 5/11
• CPT Code 95830, 5/11
• CPT Code Update 2011, 1/11
• CPT Codes 90460 and 90461:  New Codes for Immunization Administration That Include Physician Counseling for Recipients through 18 Year of Age, 1/11
• CPT Procedure Code 38724 with Modifier 50, 8/11
• CPT Procedure Code 52351 with Modifier 51, 8/11
• DHHS/DMA Program Integrity Contract with Public Consulting Group, 4/11
• Dental Program Changes, 10/11
• Dental Services and Presumptive Eligibility For Pregnancy, 10/11
• Drug Screening, 8/11
• Due Process and Prior Approval Procedures Special Bulletin, 5/11
• EHR Incentive Program Upcoming Deadlines, 11/11
• Enactment of the Affordable Care Act:
  • 4/11
  • 6/11
• Enrollment Fee Final Notice, 6/11
• Enrolling Medicaid and Health Choice Patients in Community Care of (CCNC/CA), 9/11
• Enrollment of Recipients in s SSA (Special Services for the aged) Eligibility Group into CCNC/CA (Community Care of NC, 6/11
• False Claims Act Education, 9/11
• False Claims Act Legislation, 3/11
• Family Planning Waiver, 6/11
• Family Planning Waiver Procedure Code 55205 Change, 10/11
• Family Planning Waiver Procedure Code 86781 Change, 10/11
• HCPCS Code Changes for the Physician’s Drug Program, 4/11
• Health Check Seminars:
  • 5/11
  • 6/11
• Health Choice Outpatient Specialized Therapies, 11/11
• HIPAA 5010 Implementation:
  • 4/11
  • 7/11
  • 8/11
  • 9/11
  • 10/11
  • 11/11
  • 12/11
• HIPAA 5010 Implementation – ASC X12 Version:
  • 8/11
  • 10/11
    
  • 11/11
• Gastric Bypass, 12/11
• Guidance for Electronic Signatures, 9/11
• Implementation of Additional Correct Coding Edits: Global Surgery and Evaluation and Management Codes:
  • 7/11
  • 9/11
• Implementation of Additional Correct Coding Edits: Age/Gender and Add-on Code, 6/11
• Implementation of Additional Correct Coding Edits: New Visit and Obstetric Care, 10/11
• Implementation of Additional Correct Coding Edits: Place of Service and Inpatient Only Services, 6/11
• Implementation of Additional Correct Coding Edits: Professional Duplicates:
  • 11/11
  • 12/11
• Implementation of the National Correct Coding Initiative, 1/11
• Individual Behavior Change Intervention Services Provided in Federally Qualified Health Centers and Rural Health Clinics, 2/11
• Influenza Vaccine and Reimbursement Guidelines for 2011-2012 for Medicaid And NC Health Choice, 10/11
• Intrauterine Copper Contraceptive (Paragard) and Diagnosis V25.1, 10/11
• Letter of Attestation Revision
  • 10/11
  • 12/11
• Lidoderm and Provigil/Nuvigil Prior Authorization Changes, 11/11
• Magnetoencephalography Procedure Codes 95965, 95966, 959675, 5/11
• Makena No Longer Covered Under the Outpatient Pharmacy Program, 11/11
• Medicaid and Health Choice Provider Payment Suspensions, 11/11
• Medicaid Fraud: Protect Your Tax Dollars, 10/11
• Medicaid Recipient Appeal Process/Early and Periodic Screening, Diagnosis and Treatment Seminars:
  • 1/11
  • 2/11
  • 8/11
  • 9/11
  • 10/11
• Medical Record Requests for Program Integrity Post Payment, 12/11
• Medicare Crossover Claims, 1/11
• NC Health Choice Claims Processing, 9/11
• NC Health Choice Outpatient Specialized Therapies
  • 10/11
  • 11/11
• NC Medicaid EHR Incentive Program Steps for Eligible Professionals, 12/11
• NC Medicaid EHR Incentive Program Update, 11/11
• NC Medicaid Preferred Drug List Changes, 11/11
• National Correct Coding Initiative Education:
  • 2/11
  • 3/11
• National Correct Coding Initiative Update:  Laboratory Services, 4/11
• No Copayments for Family Planning Recipients, 1/11
• Notice of Rate Reductions:
  • 10/11
  • 11/11
• Office of Medicaid Management Information System Services Provider Relations Management Team Introduction, 11/11
• Office of Medicaid Management Information System Services Website, 1/11
• Outpatient Specialized Therapies, 10/11
• Payment Error Rate Measurement in North Carolina, 1/11
• PDF Format Remittance and Status Reports, 1/11
• Physician Assistant and Nurse Practitioner Enrollment, 11/11
• Preparation for National Correct Coding Initiative Implementation, 2/11
• Procedures for PA Request for Synagis for RSV Season 2011/2012:
  • 9/11
  • 10/11
• Process for Returning Unused Mirena Units, 3/11
• Provider Application Fee, 9/11
• Provider Billing of Patients Who Are Medicaid Recipients, 3/11
• Provider Quality Assurance Questionnaire:
  • 2/11
  • 3/11
  • 4/11
  • 5/11
• Provider Responsibilities in a Program Integrity Review or Audit, 11/11
• Provider Verification, 5/11
• Radiopharmaceutical Codes, 5/11
• Recredentialing of Medicaid Providers, 12/11
• Requesting a Health Choice Review When an Adverse Decision Has Been Issued, 12/11
• Requests for Non-Covered Services: Alcohol and Drug Abuse Treatment Centers(ADTC), 6/11
• Reporting Provider Fraud and Abuse, 9/11
• Revised Timeline for the Implementation of Additional Correct Coding Edits: New Visit and Obstetric Care, 9/11
• Scheduling Hysterosalpingogram (HSG) After the Essure Procedure, 10/11
• School Based Health Center, 4/11
• Subscribe and Receive Email Alerts for Medicaid Updates:
  • 10/11
  • 11/11
• Submitting Claims for Reimbursement, 10/11
• Submitting Claims on Paper:  Optical Character Recognition Technology, 1/11
• Suspended Implementation of Place of Service Correct Coding Edits, 7/11
• Termination of Inactive Medicaid Provider Numbers:
  • 7/11
  • 9/11
• Upcoming Changes, 7/11
• Update on the N.C. Medicaid EHR Incentive Payments, 9/11
• Update on the N.C. Health Information Technology Plan and Schedule, 1/11
• Update: Provider Authorization for Non- Emergency Cardiac Imaging Procedures, 9/11
• Update to Provider Self Audit Process, 10/11
• Updated EOB Crosswalk to HIPAA Standard Codes, 3/11
• Updated EOB Code Crosswalk to HIPAA Standard Codes, 7/11
• Update to Provider Self Audit Process, 12/11
• You Can Avoid Delays with the Enrollment Process!, 4/11
• W-9, 7/11

Adult Care Home Providers:

• DMA Recipient Study, 7/11

Ambulatory Surgical Centers:

• Addition of 2010 CPT Procedure Codes to be Paid Separately to Ambulatory Surgical Centers, 2/11
• National Correct Coding Initiative Education:
  • 2/11
  • 3/11
• Reporting of Never Events and Hospital-Acquired Conditions, 4/11

Anesthesiologists:

• Clarification and Correction for CPT Codes 01967 and 01996, 3/11
• Correction and Reimbursement Requirements for AD Modifier Billing, 3/11

CAP Providers:

• CAP I/DD Policy Requirements Extension and Exception Process, 9/11
• Case Management Hours Procedural Change, 10/11
• Case Managers Claim Approvals for CAP Services, 10/11
• Preferred Supplier for Select Incontinence Products and Non-Sterile Gloves, 4/11
• Rate Revisions for Select Incontinence Product, 10/11
• Reimbursement Rates and Addition of New Pull-On Codes, 5/11

CAP/C Case Managers and Service Providers:

• Video Conference Seminars for CAP/C Case Managers and CAP/C Service Providers:
  • 1/11
  • 2/11

CAP/DA Lead Agencies and CAP/DA Service Providers:

• Policy Changes for Completing an Assessment, Completing a Reauthorization or Continued Needs Review or for a Crisis/Emergency Situation, 6/11
• The Community Alternative Program for Disabled Adults has launched a self-direction option (Consumer-Directed Care) for CAP/DA Participants, 5/11

CAP/MR-DD Service Providers:

• CAP/MR-DD Utilization Review by Local Management Entities, 1/11
  • Correction: The phone number listed for Eastpointe LME was the emergency number. The correct phone number to use for CAP/MR-DD utilization review issues is 1-800-513-4002.
• Extension of Current CAP-MR/DD Waiver and Process For Submitting Authorization Requests, 12/11
• Post-Payment Reviews by Public Consulting Group, 2/11
• Rate Revisions for Metabolic Formulas, 12/11

Certified Registered Nurse Anesthetists:

• Clarification and Correction for CPT Codes 01967 and 01996, 3/11
• Correction and Reimbursement Requirements for AD Modifier Billing, 3/11

Child Service Coordination Providers:

• Care Coordination for Children, 2/11
• Child Service Coordination Program and Maternity Care Coordination Program, 2/11

Community Care of North Carolina/Carolina ACCESS Providers:

• Carolina ACCESS Referral/Authorization Guidelines, 1/11
• Change in Carolina ACCESS Participation Requirement, 6/11
• Enrolling Medicaid/Medicare Recipients (Dually Eligible Recipients) with Your Practice, 2/11
• Marketing Restrictions, 6/11
• Per Member/Per Month (PM/PM) Rates, 10/11
• Policy Clarification Regarding 24-Hour Coverage, 3/11
• Provider Satisfaction Survey:
  • 1/11
  • 3/11
  • 4/11

Critical Access Behavioral Health Agencies (CABHA's):

• Billing Core Services “Incident To” the Medical Director or Other Critical Access Behavioral Health Agency Physician, 2/11
• CABHA Rules,11/11
• Changes in Clinical Coverage Policy 8C, 12/11
• Changes of Ownership, Mergers, and Acquisition, 2/11
• Claims for Community Support Team, Intensive In-Home, and Child and Adolescent Day Treatment Services after December 31, 2010, 1/11
• Clarification of Outpatient Behavioral Health CPT Codes, E/M Codes, Annual Limits, Referrals, and Prior Authorization, 4/11
• Clinical Coverage Policy Updates, 2/11
• Electronic Commerce Requirements for Billing, 2/11
• Frequently Asked CABHA Billing Questions, 6/11
• H Code Limits for Provisionally Licensed Professional Billing through the LME, 11/11
• Implementation of Independent Assessments For Community Support Team, 9/11
• MH/DD/SA Integrated Care Toolkit, 8/11
• New CABHA Provider Affiliation Denial Code, 6/11
• Outpatient Behavioral Health Services Seminars, 10/11
• Payment on Professional Crossover Claims, 10/11
• Peer Support Services Implementation, 7/11
• Post-Payment Reviews by Public Consulting Group, 2/11
• Proposed Changes to Medicaid Clinical Coverage Policy 8C, 8/11
• Provider Affiliation Enrollment Verification, 5/11

Dental Providers:

• American Dental Association Code Updates, 1/11
• Dental Program Changes, 10/11
• Dental Seminars:
  • 7/11
  • 8/11
  • 9/11
• NC Health Choice Dental Policy, 10/11
• Revised Orthodontic Services Clinical Coverage Policy, 8/11

Durable Medical Equipment Providers:

• 2011 HCPCS Code Changes for Durable Medical Equipment, 2/11
• National Correct Coding Initiative Education:
  • 2/11
  • 3/11
• Preferred Supplier for Select Incontinence Products and Non-Sterile Gloves, 4/11
• Prior Approval Requirement for HCPCS Code W4016 Bath Seat, Pediatric, 5/11
• Rate Revisions for Metabolic Formulas, 12/11
• Rate Revisions for Select Incontinence Products, 10/11
• Removal of Prior Approval Requirement From HCPCS Code W4016, Bath Seat, Pediatric, 3/11
• Roche ACCU-CHEK Diabetic Supplies Under the DME and Pharmacy Programs,12/11

Dialysis Facilities:

• Tigecycline, 1 mg (Tygacil, HCPCS Code J3243):  Billing Guidelines, 4/11

Enhanced Behavioral Health (Community Intervention) Services Providers:

• Behavioral Health Mobile Crisis Management, 1/11
• Claims for Community Support Team, Intensive In-Home, and Child and Adolescent Day Treatment Services after December 31, 2010, 1/11
• Critical Access Behavioral Health Agency Certification and Endorsement for Community Support Team, Intensive In-Home, and Child and Adolescent Day Treatment Services after January 1, 2011, 1/11
  • Update to Article, 1/13/11
  • Clarification, 2/11
• Medicare and Third Party Liability Bypass for Diagnostic Assessment and Partial Hospitalization, 4/11
• Post-Payment Reviews by Public Consulting Group, 2/11

Federally Qualified Health Centers:

• Antepartum Care and Postpartum Care Provided in Federally Qualified Health Center and Rural Health Clinics, 5/11
• Individual Behavior Change Intervention Services Provided in Federally Qualified Health Centers and Rural Health Centers, 5/11
• Pregnancy Medical Home Project Seminars:
  • 1/11
  • 2/11
  • 3/11

Health Departments:

• Compounded Hydroxyprogesterone Caproate, 7/11
• Electronic Claims Submission ,11/11
• Hydroxyprogesterone Caproate (Makena, HCPCS Code J3490):  Billing Guidelines, 4/11
• Makena Billing Guidelines Revised for the Physician's Drug Program , 7/11
• Omalizumab, 5 mg (Xolair, HCPCS Code J2357):  Change in Coverage:
  • 4/11
  • 5/11
• Paliperidone Palmitate Exended Release, 1 mg (Invega Sustenna,HCPCS Code J2426):  Billing Guidelines, 4/11
• Pregnancy Medical Home Project Seminars:
  • 1/11
  • 2/11
  • 3/11
• Revised Orthodontic Services Clinical Coverage Policy, 8/11

Health Department Dental Centers:

• American Dental Association Code Updates, 1/11
• Dental Program Changes, 10/11
• Dental Seminars:
  • 7/11
  • 8/11
  • 9/11
• NC Health Choice Dental Policy, 10/11

 

HIV Case Management Providers:

• Application Deadline
  • 9/11
  • 10/11
  • 11/11
  • 12/11
• Reminders and Updates for HIV Case Management Services:
  • 1/11
  • 2/11
  • 3/11
  • 4/11
  • 5/11
  • 6/11
  • 7/11
  • 8/11

Home Health Agencies:

• Peer Support Services Implementation, 7/11
• Physician Face to Face Encounter Certification Requirement, 7/11
• Preferred Supplier for Select Incontinence Products and Non-Sterile Gloves, 4/11
• Rate Revisions for Select Incontinence Product, 10/11
• Reimbursement Rates and Addition of New Pull-On Codes, 5/11

Hospice Providers:

• Physician Face to Face Encounter Requirement, 8/11
• Provision of Hospice Care for Children Under 12 Years Old, 8/11
  

Hospital Outpatient Services Providers:

• National Correct Coding Initiative Education:
  • 2/11
  • 3/11
• Reporting of Never Events and Hospital-Acquired Conditions, 4/11

Hospitals:

• Changes in Specified Time to Request a Reconsideration Review, 1/11
• Changes to UB-04 Guidelines
  • 9/11
  • 11/11
• Cost Report, 10/11
• Hospital Rates, 10/11
• Incorrect Denials for Hospital Providers of Laboratory, Radiology and Pharmaceutical, 7/11
• Interim Billing, 05/11
• NC Mental Health, Developmental Disabilities and Substance Abuse Services Health Plan Waiver, 11/11
• Reporting of Never Events and Hospital-Acquired Conditions, 4/11

ICF-MR Providers:

• Notice of Rate Reductions, 11/11
• WIRM Portal, 6/11

Independent Practitioners:

• National Correct Coding Initiative Update, 4/11

In-Home Care Providers:

• Implementation of In-Home Care (IHC) Services, 5/11
• Independent Assessment Updates and Reminders:
  • 1/11
  • 2/11

Local Education Agencies:

• 2009/2010 Local Education Agencies Cost Report, 2/11
• National Correct Coding Initiative Update, 4/11

Local Health Departments:

• Compounded Hydroxyprogesterone Caproate, 6/11

Local Management Entities:

• Behavioral Health Mobile Crisis Management, 1/11
• CAP/MR-DD Utilization Review by Local Management Entities, 1/11
  • Correction: The phone number listed for Eastpointe LME was the emergency number. The correct phone number to use for CAP/MR-DD utilization review issues is 1-800-513-4002.
• Changes in Clinical Coverage Policy 8C, 12/11
• Claims for Community Support Team, Intensive In-Home, and Child and Adolescent Day Treatment Services after December 31, 2010, 1/11
• Clinical Coverage Policy Updates, 2/11
• Critical Access Behavioral Health Agency Certification and Endorsement for Community Support Team, Intensive In-Home, and Child and Adolescent Day Treatment Services after January 1, 2011, 1/11
• Update to Article, 1/13/11
• Clarification, 2/11
• Extension of Current CAP-MR/DD Waiver and Process For Submitting Authorization Requests, 12/11
• Extension of Coverage for Provisionally Licensed Providers Billing Outpatient Behavioral Health Services through their LME, 6/11
• H Code Limits for Provisionally Licensed Professional Billing through the LME, 11/11
• MH/DD/SA Integrated Care Toolkit, 8/11
• Outpatient Behavioral Health Providers Billing to "Incident to" a Physician, 7/11
• Paliperidone Palmitate Exended Release, 1 mg (Invega Sustenna,HCPCS Code J2426):  Billing Guidelines, 4/11
• Peer Support Services Implementation, 7/11
• Post-Payment Reviews by Public Consulting Group, 2/11
• Resolution for IPRS and Medicaid Claim Denials, 11/11

Maternity Care Coordination Providers:

• Child Service Coordination Program and Maternity Care Coordination Program, 2/11
• Pregnancy Care Management Services, 2/11

N.C. Health Choice Providers:

• Audits and Post Payments Reviews, 10/11
• Changes in Behavioral Health Authorizations and Billing for Health Choice, 9/11
• Claims Denial and Retro Authorization for Services, 11/11
• Clinical Coverage Policy Update, 9/11
• Forms Required  for Processing and Payment of NC Health Choice, 10/11
• Health Choice Outpatient Specialized Therapies, 11/11
• Legislative Update, 8/11
• Medicaid and Health Choice Provider Payment Suspensions, 11/11
• New ID Cards and Referral Requirements for NC Health Choice Recipients, 10/11
• New Vaccine Billing Procedure, 10/11
• NC Health Choice Claims Processing, 9/11
• NC Health Choice Claims Processing Transition:
  • 8/11
  • 10/11
  • 12/11
• N.C. Health Choice Non-Covered Policies:
  • 2/11
  • 3/11
  • 10/11
• NC Health Choice Prior Authorization Processing Transition, 10/11
• NC Health Choice Proposed Clinical Coverage Policies, 10/11
• NC Health Choice Well Visits and Vaccines, 12/11
• Notice of Rate Reductions, 11/11
• Prior Approval Criteria Added to N.C. Health Choice Policies:
  • 4/11
  • 5/11
• Provider Responsibilities in a Program Integrity Review or Audit, 11/11
• Recipient ID Cards, 10/11
• Reminder:  N.C. Health Choice Eyeglasses Fabrication by Nash Optical Plant, 3/11
• Requesting a Health Choice Review When an Adverse Decision Has Been Issued, 12/11
• Upcoming Change to NC Health Choice Recipient Co-Payments , 9/11

Nurse Midwives:

• Clarification for Billing Multiple Birth, 4/11
• Compounded Hydroxyprogesterone Caproate:
  • 6/11
  • 7/11
• Hydroxyprogesterone Caproate (Makena, HCPCS Code J3490):  Billing Guidelines, 4/11
• Makena Billing Guidelines Revised for the Physician's Drug Program , 7/11
• Pregnancy Medical Home Project Seminars:
  • 1/11
  • 2/11
  • 3/11

Nurse Practitioners:

• Aglucosidase Alfa (Lumizyme, HCPCS Code J3590):  Billing Guidelines, 1/11
• Belimumab Injection Billing Guidelines
  • 6/11
  • 7/11
• Brentuximab Vedotin: Billing Guidelines, 12/11
• Capsaicin 8% Patch (Qutenza, HCPCS Code J7335):  Billing Guidelines, 4/11
• Ceftaroline Fosamil Acetate (Teflaro, HCPCS Code J3490):  Billing Guidelines, 3/11
• Centruorides Immune: Billing Guidelines, 12/11
• Clarification for Billing Multiple Birth, 4/11
• Compounded Hydroxyprogesterone Caproate:
  • 6/11
  • 7/11
• Denosumab (Xgeva, HCPCS Code J3590):  Billing Guidelines, 3/11
• Dexamethasone Implant, Intravitreal, 0.1 mg, 8/11
• Eribulin Mesylate (Halaven, HCPCS Code J9999):  Billing Guidelines, 3/11
• Hydroxyprogesterone Caproate (Makena, HCPCS Code J3490):  Billing Guidelines, 4/11
• Injection, Factor X111 Concentrate, 9/11
• Injection, Icatibant Acetate: Billing Guidelines, 12/11
• Injection, Von Willebrand Factor Complex (Human), Wilate, 8/11
• Ipilimumab Injection Billing Guidelines, 6/11
• Makena Billing Guidelines Revised for the Physician's Drug Program, 7/11
• Methyl Aminolevulinate (MAL) for Topical Administration, 16.8%, 1 Gram (Metvixia, HCPCS Code J7309):  Billing Guidelines, 4/11
• Nurse Practitioners Enrollment and Billing, 9/11
• Omalizumab, 5 mg (Xolair, HCPCS Code J2357):  Change in Coverage:
  • 4/11
  • 5/11
• Oxaliplatin, 7/11
• Paliperidone Palmitate Exended Release, 1 mg (Invega Sustenna,HCPCS Code J2426):  Billing Guidelines, 4/11
• Peginterferon Alfa-2B Injection Billilng Guidelines, 7/11
• Pegloticase (Krystexxa, HCPCS Code J3590):  Billing Guidelines, 3/11
  
• Pregnancy Medical Home Project Seminars:
  • 1/11
  • 2/11
  • 3/11
• Romidepsin, 1 mg (Istodax, HCPCS Code J9315): Billing Guidelines, 4/11
• Tigecycline, 1 mg (Tygacil, HCPCS Code J3243):  Billing Guidelines, 4/11

Nursing Facilities:

• Activities of Daily Living Clarification for Minimum Data Set 3.0 Validation Review, 3/11
• Minimum Data Set 3.0 Validation Seminar, 06/11
• N.C. Preadmission Screening and Resident Review Process for Out-of-State Admissions to N.C. Nursing Facilities, 3/11

OB/GYN Providers:

• Clarification for Billing Multiple Birth, 4/11
• Obstetrical Due Date for Obstetrical Ultrasounds, 1/11
• Pregnancy Medical Home Project Seminars:
  • 1/11
  • 2/11
  • 3/11

Ophthalmology Providers:

• CPT Procedure Code 76519, 07/11

Optical Providers:

• Elimination of Adult Routine Eye Exams, Refractions and Visual Aids Services, 8/11
• Elimination of Adult Routine Eye Exams, Refractions and Visual Aids Services and and Related Prior Approval and Billing Issues, 9/11

Optometrists:

• Cataract Surgery:  CPT Procedure Code 66982, 1/11

Orthotics and Prosthetics Providers:

• 2011 HCPCS Code Changes for Orthotics and Prosthetics, 2/11
• Coverage for Lower Extremity Prosthetic Components, 3/11

Outpatient Behavioral Health Providers:

• Changes in Clinical Coverage Policy, 12/11
• Clarification of National Correct Coding Initiative and Enrollment, 7/11
• Clarification of Outpatient Behavioral Health CPT Codes, E/M Codes, Annual Limits, Referrals, and Prior Authorization, 4/11
• Clarification on Units of Service for Outpatient Behavioral Health Unmanaged Visits, 3/11
• Clarification of Unmanaged Outpatient Behavioral Health Visits for Children Turning 21, 6/11
• Clinical Coverage Policy Updates, 2/11
• Extension of Coverage for Provisionally Licensed Providers Billing Outpatient Behavioral Health Services through their LME, 6/11
• H Code Limits for Provisionally Licensed Professional Billing through the LME, 11/11
• National Correct Coding Initiative Update:  Behavioral Health Services, 4/11
• National Correct Coding Initiative Update: Provisionally Licensed Professionals Billing ‘Incident To’ the Physician, 6/11
• Outpatient Behavioral Health Providers Billing to "Incident to" a Physician, 7/11
• Outpatient Behavioral Health Services Seminars:
  • 9/11
  • 10/11
• Paliperidone Palmitate Exended Release, 1 mg (Invega Sustenna,HCPCS Code J2426):  Billing Guidelines, 4/11
• Payment of Psychiatric Reduction on Professional Crossover Claims, 8/11
• Post-Payment Reviews by Public Consulting Group, 2/11
• Proposed Changes to Medicaid Clinical Coverage Policy 8C, 8/11
• Resolution for IPRS and Medicaid Claim Denials, 11/11

Peer Support Specialists:

• Peer Support Services Implementation, 7/11

Personal Care Service Providers:

• Implementation of In-Home Care (IHC) Services, 5/11
• Independent Assessment Updates and Reminders:
  • 1/11
  • 2/11

Pharmacists:

• Coverage of Prescription Vitamins and Mineral Products for N.C. Medicaid Recipient, 4/11
• Drug Utilization Review Intervention Letters, 3/11
• New Prior Authorization Requirements for Vusion Ointment, 11/11
• New Prior Authorization Requirements for Xolair Injection, 11/11
• Phase Two Policy Implementation, 8/11
• Policy Implementation: Off Label Antipsychotic Monitoring Children through Age 17, 4/11
• Roche ACCU-CHEK Diabetic Supplies Under the DME and Pharmacy Programs,12/11
• Suboxone, Subutex, and Buprenorphine Prior Authorization, 1/11
• Transition Period for Oral Inhaled Corticosteroids, Leukotrienes, and Statins, 3/11
• Upcoming Policy Implementation:  Off Label AntipsychoticMonitoring in Children through Age 17, 3/11
• Update:  Active Pharmaceutical Ingredients and Excipients, 3/11
• Vacation Supply Prescriptions Limited to Once a Year, 11/11

Physicians:

• Aglucosidase Alfa (Lumizyme, HCPCS Code J3590):  Billing Guidelines, 1/11
• Belatacept: Billing Guidelines, 11/11
• Belimumab Injection Billing Guidelines:
  • 6/11
  • 7/11
• Brentuximab Vedotin: Billing Guidelines, 12/11
• Capsaicin 8% Patch (Qutenza, HCPCS Code J7335):  Billing Guidelines, 4/11
• Care Coordination for Children, 2/11
• Ceftaroline Fosamil Acetate (Teffaro, HCPCS Code J3490):  Billing Guidelines, 3/11
• Centruorides Immune: Billing Guidelines, 12/11
• Clinical Coverage Policy Updates, 2/11
• Compounded Hydroxyprogesterone Caproate:
  • 6/11
  • 7/11
• Denosumab (Xgeva, HCPCS Code J3590):  Billing Guidelines, 3/11
• Dexamethasone Implant, Intravitreal, 0.1 mg, 8/11
• Eribulin Mesylate (Halaven, HCPCS Code J9999):  Billing Guidelines, 3/11
• Hydroxyprogesterone Caproate (Makena, HCPCS Code J3490):  Billing Guidelines, 4/11
• Injection, Factor X111 Concentrate, 9/11
• Injection, Icatibant Acetate: Billing Guidelines, 12/11
• Injection, Von Willebrand Factor Complex (Human), Wilate, 8/11
• Ipilimumab Injection Billing Guidelines, 6/11
• Makena Billing Guidelines Revised for the Physician's Drug Program , 7/11
• Methyl Aminolevulinate (MAL) for Topical Administration, 16.8%, 1 Gram (Metvixia, HCPCS Code J7309):  Billing Guidelines, 4/11
• Omalizumab, 5 mg (Xolair, HCPCS Code J2357):  Change in Coverage:
  • 4/11
  • 5/11
• Oxaliplatin, 7/11
• Paliperidone Palmitate Exended Release, 1 mg (Invega Sustenna,HCPCS Code J2426):  Billing Guidelines, 4/11
• Pegloticase (Krystexxa, HCPCS Code J3590):  Billing Guidelines, 3/11
• Peginterferon Alfa-2B Injection Billilng Guidelines, 7/11
• Physician Assistant Enrollment, 9/11
• Physicians Billing for CPT Procedure Codes 15832-15837, 7/11
• Physicians Billing for CPT Procedure Code 16035, 7/11
• Physician Referral Form for HIV Case Management Services, 2/11
• Pregnancy Care Management Services, 2/11
• Pregnancy Medical Home Project Seminars:
  • 1/11
  • 2/11
  • 3/11
• Reporting of Never Events and Hospital-Acquired Conditions, 4/11
• Romidepsin, 1 mg (Istodax, HCPCS Code J9315):  Billing Guidelines, 4/11
• Tigecycline, 1 mg (Tygacil, HCPCS Code J3243):  Billing Guidelines, 4/11

Podiatrists:

• Claims for CPT Code 29904, 29905, 29906 and 2990, 8/11
• Podiatrists Billing for CPT Procedure Codes 13160 and 29581, 1/11
• Podiatrists Billing for CPT Procedure Code 15740, 4/11
• Podiatrists Billing for CPT Procedure Code 27618, 4/11
• Podiatrists Billing for New Patient Office Visit CPT Procedure Codes 99201-99205, 7/11

Practitioners:

• National Correct Coding Initiative Education, 2/11

Pregnancy Medical Home Providers:

• Pregnancy Medical Home Project Seminars:
  • 1/11
  • 2/11
  • 3/11
• Registering for Obstetrical Ultrasounds:
  • 4/11
  • 5/11

Prescribers:

• Coverage of Prescription Vitamins and Mineral Products for N.C. Medicaid Recipient, 4/11
• Drug Utilization Review Intervention Letters, 3/11
• New Prior Authorization Requirements for Vusion Ointment, 11/11
• New Prior Authorization Requirements for Xolair Injection, 11/11
• Policy Implementation: Off Label Antipsychotic Monitoring Children through Age 17, 4/11
• Suboxone, Subutex, and Buprenorphine Prior Authorization, 1/11
• Transition Period for Oral Inhaled Corticosteroids, Leukotrienes, and Statins, 3/11
• Upcoming Policy Implementation:  Off Label AntipsychoticMonitoring in Children through Age 17, 3/11
• Update:  Active Pharmaceutical Ingredients and Excipients, 3/11
• Vacation Supply Prescriptions Limited to Once a Year, 11/11

Private Duty Nursing Providers:

• Preferred Supplier for Select Incontinence Products and Non-Sterile Gloves, 4/11
• Rate Revisions for Select Incontinence Product, 10/11
• Reimbursement Rates and Addition of New Pull-On Codes, 5/11

Provisionally Licensed Providers:

• Extension of Coverage for Provisionally Licensed Providers Billing Outpatient Behavioral Health Services through their LME, 6/11

Psychiatric Hospitals:

• Post-Payment Reviews by Public Consulting Group, 2/11

Psychiatric Residential Treatment Facilities:

• Post-Payment Reviews by Public Consulting Group, 2/11

Radiology Services:

• CPT Codes 74300, 5/11
• Mammography/Computer-Aided Detection, 5/11
• Obstetrical Due Date for Obstetrical Ultrasounds, 1/11
• Radiation Management Follow-up, 5/11

Residential Child Care Treatment Facilities:

• Post-Payment Reviews by Public Consulting Group, 2/11

Rural Health Clinics:

• Pregnancy Medical Home Project Seminars:
  • 1/11
  • 2/11
  • 3/11

Skilled Nursing Providers:

• WIRM Portal, 6/11

Targeted Case Management for Individualas with Intellectual and Developmental Disabilities:

• Extension of Current CAP-MR/DD Waiver and Process For Submitting Authorization Requests, 12/11
• Post-Payment Reviews by Public Consulting Group, 2/11