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August 2007
Medicaid Bulletin

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In This Issue . . .

NPI Articles:

All Providers:

Durable Medical Equipment Providers:

Nurse Practitioners:

Orthotic and Prosthetic Device Providers:

Personal Care Service (PCS) and Personal Care Service Plus (PCS Plus) Providers:


NPI Logo 

Attention:  All Providers

Keeping Address/Contact Information Current with DMA

If an address or phone number changes, providers are required to notify the Division of Medical Assistance (DMA) using the provider change form.  This form is located on the DMA Website.  Although this has always been a requirement, this information will become even more critical upon NPI implementation. Once NPI is implemented, address information will become a critical component of claims processing.  Failure to update address information, including zip +4, may negatively impact the ability to map the NPI to the appropriate Medicaid provider number.  Providers are now required to file claims using the zip+4 in the address fields.  The zip+4 on the claim must match the zip+4 in DMA's provider file in order for the NPI to map properly to the Medicaid provider number.

NC Medicaid staff may need to contact providers using the phone number in the DMA's provider file.  Providers are encouraged to verify that their address (physical and accounting, if applicable) and phone numbers (including area code) are up to date by contacting EDS Provider Services at 1-866-688-6696 or 919-851-8888.   

NPI - Get it! Share It! Use It! Getting one is free - Not having one can be costly!

EDS, 1-800-688-6696 or 919-851-8888

Attention:  All Providers

Basic Medicaid Seminars

Basic Medicaid seminars are being held during the month of October 2007. Seminars are intended to educate providers on the basics of Medicaid billing.

The seminar sites and dates will be announced in the September 2007 General Bulletin.  Pre-registration will be required.  Due to limited seating, registration is limited to two staff members per office.  Unregistered providers are welcome to attend if space is available.

EDS, 1-800-688-6696 or 919-851-8888

Attention:  All Providers

Clinical Coverage Policies

The following new or amended clinical coverage policies are now available on the Division of Medical Assistance's website:

The following policies have been revised to reflect the name change from Division of Facility Services to Division of Health Service Regulation:

These policies supersede previously published policies and procedures.  Providers may contact EDS at 1-800-688-6696 or 919-851-8888 with billing questions.

Clinical Policy and Programs
DMA, 919-855-4260

Attention:  All Providers

National Drug Code (NDC) Seminars Canceled for September 2007

Seminars on National Drug Code (NDC) Medicaid billing guidelines are canceled for September 2007.  The rescheduled training sessions will be posted in future Medicaid bulletins.

EDS, 1-800-688-6696 or 919-851-8888

Attention:  All Providers

New EOB, 9991 (Old CMS 1500)

Effective July 1, 2007, the 12/90 version of the CMS-1500 has been replaced with the 08/05 version.

Providers who submit the old (12/90) CMS-1500 will receive denial EOB 9991 on their remittance advice. EOB 9991 states, "Claim denied due to submission on old CMS-1500 format after 7/1/2007 deadline.  Resubmit on new CMS-1500 format.  Refer to New Claim Form Instructions Special Bulletin June 2007."

Providers who receive EOB 9991 will need to resubmit their claims on the new (08/05) CMS-1500.

EDS, 1-800-688-6696 or 919-851-8888

Attention:  All Providers

Provider Responsibilities for Claim Submissions

All providers who submit claims (on paper or electronically) to Medicaid, either directly or through a billing agent, are responsible for ensuring that the services they are billing for have been provided in accordance with state and federal rules and regulations and Medicaid clinical coverage policies.  The provider is responsible for obtaining any required prior approvals and referral authorizations prior to rendering the service.  All providers must verify that any employee or contracted staff under their supervision meets the required qualifications for the service that is being rendered and billed to Medicaid.  Medical record documentation must support the necessity for the services and must be maintained in accordance with all federal and state rules and regulations and Medicaid clinical coverage policies.

Your signature on the claim form certifies that:

For additional information on medical record documentation, service requirements, provider qualifications, and conditions of participation, refer to the DMA's Provider web page.

Clinical Policy and Programs
DMA, 919-855-4260

Attention: All Providers

Registration for Early Periodic Screening and Diagnostic Testing (EPSDT) Seminars

Early Periodic Screening and Diagnostic Testing (EPSDT) seminars will begin in September 2007.  Registration information, a list of dates, and site locations for the seminars are listed below.

Seminars will begin at 9:00 a.m. and will end at 12:00 noon.  Providers are encouraged to arrive by 8:45 a.m. to complete registration.  Lunch will not be provided at the seminars.  Because meeting room temperatures vary, dressing in layers is strongly advised.

Pre-registration is required.  Unregistered providers are welcome to attend if space is available.  Providers may register for the seminars by completing and submitting the registration form online under "Seminar Information." Please indicate on the registration form which session you plan to attend.

The EPSDT information (training slides) presented during the seminar will be available on the DMA EPSDT web page by August 15.  Please review, print, and bring the slides to the seminar.

Tuesday, September 18
Crowne Plaza
One Resort Drive
Asheville, NC

Wednesday, September 19
Holiday Inn Conference Center
530 Jake Alexander Blvd. South
Salisbury, NC

Tuesday, September 25
Prince Charles Clarion Hotel
450 Hay St.
Fayetteville, NC

Thursday, October 4
Jane S. McKimmon Center
1101 Gorman St.
Raleigh, NC

Wednesday, September 26
Hilton Greenville
207 SW Greenville Blvd.
Greenville, NC


Directions to the EPSDT Seminars

Crowne Plaza - Asheville
Traveling East on I-40:  Take Exit 46 (left exit) for I-240 East. Continue on I-240 and stay the left lane. Take Exit 3A. Circle around right and exit onto Patton Avenue. Turn right at the second light into Regent Business Park (between Denny's and Pizza Hut). Turn right; the entrance is on the left around a curve approximately 1000 yards. Follow Resort Drive to the main entrance of the resort on the left.

Traveling West on I-40:  Take Exit 53 to I-240 West. Pass downtown Asheville. As you cross the French Broad River Bridge, stay in the right lane and take Exit 3B - Westgate and Resort Drive (formerly Holiday Inn Drive). Pass the Westgate Shopping Center on your right. After passing Mr. Transmission, you will see our entrance sign. Turn right onto Resort Drive and proceed to the main entrance.

Hilton - Greenville
Traveling East:  take US-64 East to US-264 East. Follow 264 East to Greenville. Turn right on Allen Rd. once you enter Greenville. Go approximately 2 miles and Allen Rd. turns into Greenville Blvd./Alternate 264. Follow Greenville Blvd. for 2-1/2 miles; the Hilton Greenville is located on the right.

Traveling South:  Take US-64 to US-13 S/NC-11 S. Continue to follow NC-11 S. Turn left onto Greenville Blvd. The hotel is on the left.

Traveling North:  Take NC-11 North to Greenville. Turn right onto Greenville Blvd. Hotel is approximately one mile ahead on the right.

Jane S. McKimmon Center  - Raleigh
Traveling East on I-40:  Take exit 295 and turn left onto Gorman Street. Travel approximately 2.5 miles. The McKimmon Center is located on the right on the corner of Gorman Street and Western Boulevard.

Traveling West on I-40:  Take exit 295 and turn right into Gorman Street. Travel approximately 2.5 miles. The McKimmon Center is located on the right on the corner of Gorman Street and Western Boulevard.

Holiday Inn Conference Center - Salisbury
Traveling South on I-85:  Take exit 75. Turn right onto Jake Alexander Boulevard. Travel approximately half a mile. The Holiday Inn is located on the right.

Traveling North on I-85:  Take exit 75. Turn left onto Jake Alexander Boulevard. Travel approximately half a mile. The Holiday Inn is located on the right.

Prince Charles Clarion Hotel - Fayetteville
From the Fayetteville Regional Airport, the approximate distance to the hotel is 7 miles.

Traveling on I-95:  Follow I-95-Business North.  Turn right onto NC-87 North.  Continue on US-401-Business North.  Take Exit 104B/Hay Street toward downtown.  Turn right on Hay Street.  The hotel is located on the left.

Attention: Durable Medical Equipment Providers

Prior Approval for Pediatric Mobility Devices

Until further notice, Children's Special Health Services (CSHS) will continue reviewing requests for prior approval for pediatric mobility devices on behalf of DMA.  Providers should continue to submit their prior approval requests to CSHS utilizing the same procedures established in Clinical Coverage Policy 5A, Durable Medical Equipment, accessible from DMA's Web site.  Refer to Attachment B, How a Recipient Obtains Durable Medical Equipment and Supplies, for detailed instructions.

EDS, 1-800-688-6696 or 919-851-8888

Attention: Durable Medical Equipment and Orthotic and Prosthetic Device Providers

Change in Prior Approval Process for Non-Listed Durable Medical Equipment, Orthotic and Prosthetic Devices, and Medical Supplies for Recipients under 21 Years of Age

Effective with date of request August 1, 2007, providers must submit prior approval requests for items that are not listed on the durable medical equipment or orthotic and prosthetic fee schedules when these items are medically necessary for Medicaid recipients under 21 years of age.  Providers should submit the requests to the Assistant Director for Clinical Policy and Programs, Division of Medical Assistance (DMA).  Please use the Non-Covered State Medicaid Plan Services Request Form for Recipients under 21 Years of Age, which can be found on DMA's Provider Forms web page in the Prior Approval section.

EDS, 1-800-688-6696 or 919-851-8888

Attention: Personal Care Service (PCS) and Personal Care Service Plus (PCS Plus) Providers

Provider Training Sessions

The Carolina Centers for Medical Excellence (CCME; www.thecarolinascenter.org) announces continued provider training for Personal Care Services (PCS) as approved by the Division of Medical Assistance (DMA).

The 3rd calendar quarter training sessions of 2007 (PCS Provider Training Session V) will be conducted in September 2007.  The training is recommended for registered nurses, agency administrators, and agency owners who have a working knowledge of the PCS program and applicable DMA policies. 

Specific dates and locations will be posted soon on CCME's registration site.  Pre-registration, either online or by fax, is required.  Space is limited to 150 participants at each session.

To register online, visit the registration site and complete the registration process.  You will be issued a computer-generated number to confirm your registration.  To register by fax, please complete the form following this announcement and fax it to the attention of Jennifer Manning at 919-380-9457.  A member of the PCS team will contact you with a registration number.  If you need to cancel at any time, please contact Jennifer Manning (voice 919-380-9860, x2018; e-mail jmanning@thecarolinascenter.org) to allow others to attend those sessions that fill up early.

Because meeting room temperatures vary, dressing in layers is strongly advised.  Sign-in will start at 8:00 a.m. at each location.  The presentations will begin at 9:00 a.m. and continue until 1:30 p.m. There will be one or two 15-minute breaks, but only coffee, hot tea, and water will be provided, so please plan ahead for the late lunch hour.  This schedule allows us to offer 4.25 Continuing Nursing Education (CNE) contract hours to all nurses at no cost to the participants.

 Jennifer Manning, CCME, 919-380-9860, ext 2018 

Attention: Physicians and Nurse Pracitioners

Cytarabine Liposome (DepoCyt, HCPCS Procedure Code J9098) - Billing Guidelines

Effective with date of service January 1, 2007, the N.C. Medicaid Physician's Drug Program covers DepoCyt when billed with HCPCS procedure code J9098.  DepoCyt is a sustained-release formulation of the active ingredient cytarabine, an antimetabolite that acts through inhibition of DNA synthesis and is cell cycle-specific for the S phase of cell division. The liposomal formulation allows for gradual release, resulting in prolonged exposure. DepoCyt, which is for intrathecal administration only, is indicated for the treatment of lymphomatous meningitis.

For Medicaid Billing:

For Medicaid billing, one unit of coverage is 10 mg. The maximum reimbursement rate for one unit is $394.20.

EDS, 1-800-688-6696 or 919-851-8888

Attention: Physicians

Attending Provider Addresses

In preparation for NPI implementation, DMA began initiating mailings to providers of record, based on information contained in our Medicaid database.  From our first NPI mailing, DMA received returned correspondence for more than 2,000 providers. The majority of these providers were individual attending physicians.

The returned correspondence indicated that the address was unknown or the mail was undeliverable to the address currently on the database.  Many group practices have current addresses on file, but the addresses of the attending physicians must be updated and must contain the required NPI information.

To update a provider address, please submit the Provider Change Form and enclose that with the required NPI information.  If the NPI information is currently on file, only the provider change form is needed to update the address.  Since updating the Medicaid database is essential for successful NPI testing and claims processing, providers identified as having undeliverable or unknown addresses will be suspended for a bad address starting November 1, 2007.  Once the provider number is suspended, any claims submitted including that provider number will suspend.

Once the address is corrected, any suspended claims will be released for processing.  For group providers, remember that claims submitted using suspended attending provider numbers will also suspend, so please verify that all address information is correct in the Medicaid database.

To verify the address of a physician listed in the Medicaid provider database, please contact EDS Provider Services at 1-800-688-6696. Remember, EDS can not update the address or the NPI; EDS can only verify the address or NPI listed on the database.  If the address is incorrect, please complete a provider change form using the link above. Address changes typically require 6-8 weeks to process.

EDS, 1-800-688-6696 or 919-851-8888

Proposed Clinical Coverage Policies

In accordance with Session Law 2005-276, proposed new or amended Medicaid clinical coverage policies are available for review and comment on DMA's website.  To submit a comment related to a policy, refer to the instructions on the website.  Providers without Internet access can submit written comments to the address listed below.

Loretta Bohn
Division of Medical Assistance
Clinical Policy Section
2501 Mail Service Center
Raleigh, NC 27699-2501

The initial comment period for each proposed policy is 45 days.  An additional 15-day comment period will follow if a proposed policy is revised as a result of the initial comment period.

2007 Checkwrite Schedule


Electronic Cut-Off Date

Checkwrite Date




















































Electronic claims must be transmitted and completed by 5:00 p.m. on the cut-off date to be included in the next checkwrite.  Any claims transmitted after 5:00 p.m. will be processed on the second checkwrite following the transmission date.

Mark T. Benton, Director   Cheryll Collier
Division of Medical Assistance   Executive Director
Department of Health and Human Services   EDS


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