Meeting Annual Consider With Prophylactic Surgeries In North Carolina
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Starting Jan. 1, 2025, we're switching State Health Plan Third-Party Administrator (TPA) services from Blue Cross NC to Aetna. We look forward to enhanced benefits that Aetna will offer our members.
Effective with date of service Aug. 1, 2023, the NC Medicaid programs cover the RSV vaccine, adjuvanted suspension for intramuscular injection (Arexvy) for when billed with HCPCS code 90679 - Respiratory syncytial virus vaccine, preF, recombinant, subunit, adjuvanted, for intramuscular use.
The EP modifier identifies the type of service provided to Medicaid members under age 21. Claims will be denied if the section is left blank on CMS-1500 or UB04 forms.
North Carolina Medicaid provides health care coverage for low-income individuals and families who cannot afford it. NC Medicaid assistance goes further in improving the lives of North Carolinians of all ages.
General Timely Filing Limits: Many states adhere to the basic norm of submitting claims within a year after the date of service, even if the specific filing dates may alter.
For NC Medicaid Direct, LME/MCOs may require claims be submitted within 90 days of the service prior to 7/1/2024. The 365 day time frame is effective July 1, 2024. This applies to the original claim submission and any subsequent corrected claims. For Tailored Plans, the 365 day time frame is effective July 1, 2024.
Corrected Claim Submission: EDI Claims Corrections can be sent in an electronic format. On the CMS-1500 Form, use Corrected Claim Indicator (Medicaid Resubmission Code). Enter the frequency code "7" in the "Code" field and the original claim number in the "Original Ref No." field.
On December 1, 2023, NC Medicaid expanded to cover people ages 19 through 64 up to 138% of the federal poverty line. That's about $1,730/month for singles and $2,970/month for families of three. NC Medicaid covers most health services.
The Commission shall declare confirmed HIV infection to be a reportable communicable condition. (1893, c.
Time Limits for Filing Claims Medicaid hospital inpatient and nursing facility claims must be received within 365 days of the last date of service on the claim. NC Medicaid has checkwrites 50 weeks of the calendar year – no checkwrites occur the week of June 30 and the week of Christmas.
