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April 2009
Medicaid Bulletin

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In This Issue . . .


All Providers:

Community Alternatives Program Providers:

Dental Providers:

Health Department Dental Centers:

Nurse Practitioners:

Personal Care Services Providers:



Attention:  All Providers

Use of the Medicaid Provider Number After National Provider Identifier Implementation

Although providers will not be able to submit Medicaid Provider Numbers (MPNs) on claims after May 1, 2009, they must still use the MPN for the following reasons:

Providers will continue to receive a MPN as part of the enrollment process. In addition, providers will continue to see the MPN on paper Remittance and Status (RA) reports. 

Please have your MPN accessible when contacting N.C. Medicaid.

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:  Community Alternatives Program Providers and Personal Care Services Providers

Recommended Taxonomy Code for National Provider Identifier Mapping

For providers who have one National Provider Identifier (NPI) that represents both a Community Alternatives Program (CAP) and a Personal Care Services (PCS) Medicaid Provider Number (MPN), submit taxonomy code 3747P1801X on all claims.  If the recipient is eligible for CAP, the claim will map to the CAP provider number.  Otherwise, it will map to the PCS provider number.  Do not use taxonomy code 251E00000X, which indicates a home health agency, in this scenario.  Claims billed with a taxonomy code other than 3747P1801X may not map to the correct MPN and may, therefore, result in a denied claim.

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

Are You Ready for National Provider Identifiers?

Providers have only one more month to prepare for National Provider Identifier (NPI) implementation.  Are you ready?   As a reminder, after May 1, 2009, Medicaid Provider Numbers (MPNs) will no longer be allowed on paper or electronic claims, with only a few exceptions.  (Refer to Use of the Medicaid Provider Number after National Provider Identifier Implementation for details).  The following checklist will assist you with NPI preparation:

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

Medicaid Recipient/Applicant Due Process Appeals for Medical, Dental, and Behavioral Health Services

North Carolina S.L. 2008-118, s. 3.13, effective July 1, 2008, eliminated Medicaid informal appeals with the Department of Health and Human Services (DHHS) Hearing Office as a hearing option for Medicaid recipients and applicants beginning October 1, 2008.  Only a formal or fair hearing before the Office of Administrative Hearings (OAH) is required for adverse decisions made about a Medicaid recipient’s or applicant’s medical, dental, or behavioral health service requests.  The law specifies deadlines (see appeal timeline) throughout the formal hearing process that must be met by OAH and DHHS.  The fair or formal hearing process, exclusive of a request for judicial review, must be completed within 90 days of the recipient’s/applicant’s filing with OAH and the DHHS General Counsel.

Since the law was enacted, OAH, the Mediation Network of North Carolina, and DMA have been working cooperatively to develop policies and procedures to implement the appeal process.  DMA has created new notices and a recipient appeal request form and distributed them to staff and vendors for implementation.  Additionally, DMA has developed an electronic system that will manage all appeal documents, track the status of individual appeals, and collect data regarding the efficiency, effectiveness, and cost effectiveness of the new appeal process.  Lastly, DMA has trained its staff, vendors, and mediators regarding the new appeal process.

A brief overview of the hearing process appears below.  This overview is not meant to provide an in-depth explanation of all hearing procedures.  DMA expects to publish a detailed Special Bulletin on the appeal process once policies and procedures have been completed with OAH. 

The next phase of implementation of North Carolina S.L. 2008-118 is provider training and recipient notification about the new appeals process.  Questions about the appeal process may be directed to either OAH or DMA’s Appeals Unit.

Appeals Unit
DMA, 1-800-662-7030 or 919-855-4260

Attention:  All Providers

Provider Exclusions, Fraud, and Abuse

CMS requires every state to remind providers to screen their employees and contractors for excluded persons.  The information below outlines this requirement and also gives specific instructions to providers on how to access the list of individuals excluded by the Health and Human Services Office of Inspector General (HHS-OIG). 

The HHS-OIG excludes individuals and entities from participation in Medicare, Medicaid, the State Children’s Health Insurance Program (SCHIP), and all federal health care programs [as defined in section 1128B(f) of the Social Security Act (the Act)] based on the authority contained in various sections of the Act, including sections 1128, 1128A, and 1156.

When the HHS-OIG has excluded a provider, federal health care programs (including Medicaid and SCHIP programs) are generally prohibited from paying for any items or services furnished, ordered, or prescribed by excluded individuals or entities [Section 1903(i)(2) of the Act; and 42 CFR section 1001.1901(b)].  This payment ban applies to any items or services reimbursable under a Medicaid program that are furnished by an excluded individual or entity, and extends to

The following list sets forth some examples of the types of items or services that are reimbursed by Medicaid that, when provided by excluded parties, are not reimbursable:

To protect against payments for items and services furnished or ordered by excluded parties, DMA advises all current providers, and providers applying to participate in the N.C. Medicaid Program, to take the following steps to determine whether their employees and contractors are excluded individuals or entities:

Compliance with this obligation is a condition of participation for N.C. Medicaid and DMA will notify the HHS-OIG promptly of any administrative action taken against a provider who fails to comply with these screening and reporting obligations.

Civil monetary penalties may be imposed against Medicaid providers and managed care entities (MCEs) who employ or enter into contracts with excluded individuals or entities to provide items or services to Medicaid recipients.

Where Providers Can Look for Excluded Parties
The HHS-OIG maintains the List of Excluded Individuals/Entities (LEIE) as a database that is accessible to the general public.  The database provides information about parties excluded from participation in Medicare, Medicaid, and all other federal health care programs.  The LEIE website is available in two formats.  The online search engine identifies currently excluded individuals or entities.  When a match is identified, it is possible for the searcher to verify the accuracy of the match using a Social Security Number (SSN) or Employer Identification Number (EIN).  The downloadable version of the database may be compared against an existing database maintained by a provider.  However, unlike the online format, the downloadable database does not contain SSNs or EINs.

Monica T. Jones, Provider Services
DMA, 919-855-4050

Attention:  All Providers

Computer Sciences Corporation to Assume N.C. Medicaid Provider Enrollment, Credentialing, and Verification Activities

DMA is pleased to announce that Medicaid provider enrollment, credentialing, and verification functions will be transferred from DMA Provider Services to Computer Sciences Corporation (CSC) in late April 2009.  This change will result in timelier processing of provider enrollment applications and will increase the support available to providers in need of assistance with enrollment and maintenance activities. 

Please note that EDS will continue to perform all other provider support functions. Providers will continue to call EDS for claim status, checkwrite information, billing problems, etc., just as they do today.  At this time, CSC will assume responsibility for only provider enrollment, credentialing, and verification activities. 

Effective April 20, 2009, providers will mail all Medicaid enrollment forms, including applications, agreements, Medicaid Provider Change Forms, and Carolina ACCESS applications and agreements, to CSC at the address shown in the chart below.  Providers accessing the DMA website for enrollment information after April 20, 2009, will be redirected to the CSC website to obtain provider enrollment forms. 

CSC will operate a dedicated Medicaid Provider Enrollment, Verification, and Credentialing (EVC) Call Center for providers to inquire on the status of their Medicaid applications or change requests.  The EVC Call Center hours of operation will be 8:00 a.m. to 5:00 p.m., Monday through Friday, except for State approved holidays.   The toll-free CSC telephone and fax numbers are shown in the chart below. 

Calls to the EVC Call Center will be answered by representatives who specialize in provider enrollment and credentialing functions.  CSC will log and track information captured during the call in order to ensure consistent quality of all inquiry responses. CSC’s goal is to resolve inquiries in the initial call.  If additional research or escalation is necessary, a response and resolution will be provided within 48 hours of receipt of the call.  

The EVC Call Center will be staffed with experienced health care professionals who will provide support in the following areas: 

CSC will accommodate many methods of provider communication including telephone, e-mail, fax, and written correspondence.  All correspondence coming through the EVC Call Center will be maintained in a central repository to allow easy access to and quick retrieval of provider inquiries.

Beginning in April, CSC will also initiate a process to verify information for currently enrolled Medicaid providers.  In accordance with CMS requirements for Medicaid participation (42 CFR.455.100 through 106), CSC will initiate credentialing activities for those enrolled providers who have not been credentialed in the last 14 months.   CSC will notify providers when verification and credentialing activities will begin for their provider types.  

DMA and CSC will continue to inform providers of various events and changes through the general Medicaid Bulletin, the DMA website, and the CSC website to ensure a smooth and seamless transition of enrollment, credentialing, and verification activities.  

Beginning April 20, 2009, the CSC website can be accessed at http://www.nctracks.nc.gov. In addition to enrollment forms and enrollment/credentialing information, the website will also include instructions for completing forms, frequently asked questions, and other information to ensure that providers are well informed in advance of submitting applications. 

EVC Call Center Contact Information

Enrollment, Verification, and Credentialing Call Center Toll-Free Number


EVC Call Center Fax Number


EVC Call Center E-Mail Address


CSC Mailing Address

N.C. Medicaid Provider Enrollment
PO Box 300020
Raleigh NC 27622-8020

CSC Site Address

N.C. Medicaid Provider Enrollment
2610 Wycliff Road, Suite 102
Raleigh NC 27607

CSC Website Address http://www.nctracks.nc.gov

Refer to DMA’s website for more information about CSC and the development and implementation of the Replacement Medicaid Management Information System (MMIS).

Linda Pruitt
DMA, 919-855-4106

Attention:  All Providers

Undeliverable Mail

Currently, if a Remittance and Status Report (RA) or check cannot be delivered due to an incorrect billing address in the provider’s file, all claims for the provider number are suspended and the subsequent RAs and checks are no longer printed.  Automatic deposits are also discontinued. 

Effective April 20, 2009, any correspondence, including RAs or checks, that is returned to DMA, CSC or EDS as undeliverable due to an incorrect billing address will result in the suspension of the provider number.

Once a suspension has been placed on the provider number, the provider has 90 days to submit an address change.  After 90 days, if the address has not been corrected, suspended claims will be denied and the provider number will be terminated.  Once terminated, a provider must complete a new application and agreement to re-enroll and may have a lapse in eligibility as a Medicaid provider.

Provider Services
DMA, 919-855-4050

Reporting a Change in Provider Status

Attention:  All Providers

Top 10 List of Helpful Hints When Billing National Drug Codes

#10:      Report Epogen and Procrit National Drug Code (NDC) units as milliliters.

#9:        Do not use HCPCS procedure code J2405 (injection, ondansetron HCl, per 1 mg) to bill for ondansetron tablets.  J2405 is for injections only.

#8:        Rule of thumb:  If the drug is in powder form in the vial, report the number of vials of powder administered for the NDC units.  An example of NDC in powder form is ceftriaxone 500-mg vial.

#7:        Rule of thumb:  If the drug is in liquid form in the vial, report the number of milliliters administered for the NDC units.  An example of NDC in liquid form is promethazine 25 mg/ml.

#6:        When billing HCPCS procedure codes J1055 (injection, for contraceptive use, per 150 mg) or J1051 (injection, per 50 mg) for medroxyprogesterone acetate (Depo-Provera), bill the number of milliliters administered, not the number of milligrams. 
Note: For professional claims, bill J1055 with the FP modifier.

#5:        The correct HCPCS procedure codes for methylprednisolone sodium succinate (Solu-Medrol) are J2930 and J2920.  Be sure the HCPCS code billed corresponds to the NDC of the steroid administered.

#4:        When billing more than one NDC for a HCPCS code, be sure that the NDC units correspond to the dose being reported for the HCPCS units.  The HCPCS units and the total NDC units, when reviewed separately, should report the same dose.
Example:  A patient receives a 150-mg dose of Eloxatin.  Report 300 units for J9263 (injection, oxaliplatin 0.5 mg).  For Eloxatin 100 mg/20 ml report NDC units as 20 ml; for Eloxatin 50 mg/10 ml report NDC units as 10 ml (30 ml equals a 150-mg dose).

#3:        Use HCPCS procedure codes J0560, J0570, and J0580 to bill for penicillin G benzathine (Bicillin LA).  Use HCPCS procedure codes J0530, J0540, and J0550 to bill for the combination product, penicillin G benzathine and penicillin G procaine (Bicillin CR).

#2:        Morphine, promethazine, and penicillin G benzathine have specific HCPCS codes.  It is not correct to bill multiple unrelated NDCs under J3490 unless billing for a compound.  In the future, claim details will be denied when miscellaneous HCPCS codes (J3490, J3590, and J9999) are billed with NDCs that have an assigned HCPCS code.

#1:        “Milligram” is not a valid unit of measure for NDC units. Do not report the number of milligrams administered as the NDC units.  The four required units of measure quantity codes are

Remember to use the specific code for the procedure or service performed.  Refer to HCPCS coding guidance and the narrative description of the codes to identify the appropriate code for the service performed.  If there is not a specific code that accurately identifies the service, use the appropriate unlisted service code.  For example,  

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

Attention:  All Providers

Denials for Endovascular Graft Repair of Thoracic Aortic Aneurysm

Effective with date of service December 1, 2006, N.C. Medicaid has covered endovascular graft repair of thoracic aortic aneurysm (see Clinical Coverage Policy #1A-21).  However, providers have continued to receive denials related to EOB 9 (service not covered by the Medicaid program).

System updates have now been completed to correct this issue.  Providers who received claim denials related to EOB 9 and have kept their claims timely for CPT codes 33880, 33881, 33883, 33884, 33886, 33889, and 33891, and associated radiology codes 75956, 75957, 75958, and 75959, may submit new claims (not adjustments) for processing following time limit procedures.

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 DMA’s website:

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

Medicaid Fraud and Abuse – Confidential Online Complaint Form


DMA’s Program Integrity Section is devoted to ensuring that Medicaid payments are accurate and that fraud, waste or program abuse are identified and reported.  To assist Program Integrity and to better serve the citizens of North Carolina to prevent Medicaid fraud, waste or program abuse, we have created a new confidential Online Complaint Form.

How to Report Suspected Medicaid Fraud, Waste and Program Abuse
DMA’s Program Integrity Section has a new confidential Online Complaint Form that will now allow you to promptly report suspected Medicaid fraud, waste or program abuse.  Everyone is encouraged to report matters involving Medicaid fraud, waste and program abuse.  Anyone that reports suspected Medicaid fraud, waste or program abuse via this confidential online complaint form may remain anonymous by indicating this on the form.  All complaints of misconduct are kept confidential and are protected from disclosure according to the N.C. State Administrative Procedure Act, Sections 10A NCAC 21A.0403.  Program Integrity will not reveal the identity of the complainant to any person, except as required by law.

Where to Find Program Integrity Confidential Online Complaint Form
DMA’s Program Integrity confidential Online Complaint Form is available on the Program Integrity webpage.  Everyone now has the ability to complete and submit this form electronically online.

Manny Baksh, Program Integrity
DMA, 919-647-8000

Attention:  All Providers

Corrected Diagnosis List for CPT Codes 93228 and 93229

In the January 2009 Medicaid Bulletin, the diagnosis list for CPT codes 93228 (wearable mobile cardiovascular telemetry with electrocardiographic recording, concurrent computerized real time data analysis and greater than 24 hours of accessible ECG data storage with ECG triggered and patient selected events transmitted to a remote attended surveillance center for up to 30 days; physician review and interpretation with report) and 93229 (technical support for connections and patient instructions for use, attended surveillance, analysis and physician prescribed transmission of daily and emergent data reports) was incorrect. 

The correct diagnoses required when billing these codes are listed below and in Clinical Coverage Policy #1R-4, Electrocardiography, Echocardiography, and Intravascular Ultrasound, on DMA’s website.

Ambulatory Cardiac Event Recorders—Primary Diagnosis Allowed
CPT Procedure Codes 93228, 93229, 93268 through 93272

ICD-9-CM Code


410.00 through 410.92

Acute myocardial infarction


Intermediate coronary syndrome

413.0 through 413.9

Angina pectoris


Other specified forms of chronic ischemic heart disease


Chronic ischemic heart disease, unspecified

426.0 through 426.9

Conduction disorders

427.0 through 427.9

Cardiac dysrhythmias


Syncope and collapse


Dizziness and giddiness


Tachycardia, unspecified



786.00 through 786.59

Chest pain


Following completed treatment with high-risk medications, not elsewhere classified

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

Attention:  Dental Providers and Health Department Dental Centers

Transfer of Dental Records

Providers are reminded to provide records of diagnostic quality when transferring dental records to another provider or directly to a recipient.  Since bitewing radiographs are allowed once a year and panoramic films and intraoral complete series are allowed once every five years, it is imperative that the films/images that are transferred are of diagnostic quality so the provider receiving the radiographs can make a proper diagnosis regarding treatment.

Rules of the North Carolina State Board of Dental Examiners state “A dentist shall, upon request by the patient of record, provide original or copies of radiographs and a summary of the treatment record to the patient or to a licensed dentist identified by the patientA fee may be charged for duplication of radiographs and diagnostic materials.  The treatment summary and radiographs shall be provided within 30 days of the request and shall not be contingent upon current, past or future dental treatment or payment of services.” [21 NCAC 16T.0102]

Medicaid policy does not prohibit a dentist from charging a record duplication fee to a Medicaid recipient, provided the same fee is charged to private-pay patients.  Board rules do not set a maximum level for this duplication fee.  When DMA or EDS requests records (to verify medical necessity or accuracy of billing), providers do not receive compensation.

Dental Program
DMA, 919-855-4280

Attention:  Nurse Practitioners and Physicians

Bendamustine (Treanda, HCPCS Procedure Codes J9999 and J9033) – Additional Diagnosis Codes

Effective with date of service November 1, 2008, to align with FDA approval, the N.C. Medicaid Program covers bendamustine (Treanda) for the treatment of indolent B-cell non-Hodgkin’s lymphoma that has progressed during or within six months of treatment with rituximab or a rituximab-containing regimen.  This is in addition to the existing coverage of treatment for chronic lymphocytic leukemia.

Effective with date of service January 1, 2009, providers must bill for Treanda using HCPCS procedure code J9033 (Injection, bendamustine HCl, 1 mg).

For Medicaid Billing
Refer to the table below for guidance on the ICD-9-CM diagnosis codes required for billing Treanda.

Dates of Service

HCPCS Procedure Code

ICD-9-CM Diagnosis Code

ICD-9-CM Diagnosis Code Description

March 1, 2008, through September 30, 2008



Encounter for antineoplastic chemotherapy



204.10 through 204.11

Lymphoid leukemia, chronic, without mention of remission, in remission

October 1, 2008, through October 31, 2008



Encounter for antineoplastic chemotherapy



204.10 through 204.12

Lymphoid leukemia, chronic, without mention of remission, in remission or in relapse

November 1, 2008, through December 31, 2008



Encounter for antineoplastic chemotherapy



204.10 through 204.12

Lymphoid leukemia, chronic, without mention of remission, in remission or in relapse

OR one of these non-Hodgkin’s lymphoma diagnosis codes:

  • 200.00 through 200.88

Lymphosarcoma and reticulosarcoma and other specified malignant tumors of lymphatic tissue

  • 202.08 through 202.98

Other malignant neoplasms of lymphoid and histiocytic tissue

January 1, 2009, and after



Encounter for antineoplastic chemotherapy



204.10 through 204.12

Lymphoid leukemia, chronic, without mention of remission, in remission or in relapse

OR one of these non-Hodgkin’s lymphoma diagnosis codes:

  • 200.00 through 200.88

Lymphosarcoma and reticulosarcoma and other specified malignant tumors of lymphatic tissue

  • 202.08 through 202.98

Other malignant neoplasms of lymphoid and histiocytic tissue

The Physician’s Drug Program Fee Schedule is available on DMA’s website.

Providers who received claim detail denials related to the diagnosis of  non-Hodgkin’s lymphoma for dates of service November 1, 2008, and after may resubmit the denied charges as new claims (not as adjustment requests) for processing.

EDS, 1-800-688-6696 or 919-851-8888 

Attention: Nurse Practitioners and Physicians

Plerixafor Injection (Mozobil, HCPCS Procedure Code J3490) – Correction to Reimbursement Rate

Effective with date of service December 1, 2008, the N.C. Medicaid program covers plerixafor injectable (Mozobil) for use in the Physician’s Drug Program when billed with HCPCS procedure code J3490 (unclassified drug).  The maximum reimbursement rate published in the March 2009 general Medicaid bulletin was incorrect.  The correct maximum reimbursement rate for 1 mg of Mozobil is $292.97.

The Physician's Drug Program Fee Schedule is available on DMA's website.

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

Attention:  Nurse Practitioners and Physicians

Testosterone Pellets (Testopel, HCPCS Procedure Code S0189) – Billing Guidelines

Effective with date of service November 5, 2008, N.C. Medicaid covers testosterone pellets (Testopel) for use in the Physician’s Drug Program when billed with HCPCS procedure code S0189 (testosterone pellet, 75 mg).  Testopel is available as 75-mg pellets.

Testopel is indicated as an androgen replacement therapy in the treatment of delayed male puberty and male hypogonadism (primary or hypogonadotropic).  Implantable testosterone pellets are considered experimental and investigational for other indications.  Although Testopel is indicated for male use only, androgens are contraindicated in men with carcinomas of the breast or with known or suspected carcinomas of the prostate.

Testopel is administered as a subcutaneous implantation every 3 to 6 months.  The recommended dose for Testopel is 150 mg (2 units) to 450 mg (6 units).

For Medicaid Billing

The Physician's Drug Program Fee Schedule is available on DMA's website.

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

Attention: All Providers

Registration for Health Check/EPSDT Seminars

Health Check/EPSDT seminars are scheduled for May 2009.  Information presented at the Health Check/EPSDT seminars is applicable to all providers who provide early and regular medical and dental screenings for Medicaid recipients under the age of 21. 

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.

Due to limited seating, registration is limited to two staff members per office.  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 online registration form.   Or, providers may complete the Seminar Registration Form and fax it to the number listed on the form.  Please indicate the session you plan to attend on the registration form.

The April 2009 Special Bulletin, Health Check Billing Guide 2009, will be used as the primary training document for the seminar.  Please review and print the Special Bulletin and bring it to the seminar. 

May 12, 2009
Wake Technical Community College
Student Services Building
9101 Fayetteville Rd.
Raleigh  NC  27603

May 14, 2009
Holiday Inn Wilmington
5032 Market St.
Wilmington  NC  28405

May 20, 2009
Western Piedmont Community College
Moore Hall Auditorium
1001 Burkemont Ave.
Morganton  NC  28655

Directions to the Health Check/EPSDT Seminars

Wake Technical Community College, Student Services Building
Take I-440 to US 401 South/S. Saunders Street (exit 298).  Stay to the right to continue on US 401 South/Fayetteville Road.  Continue to travel on US 401 South/Fayetteville Street towards Fuquay-Varina.  The college is located on the left approximately one mile from the intersection with NC 1010.  Turn left onto Chandler Ridge Circle.  Visitor parking is on the left.

Holiday Inn Wilmington
Traveling East on I-40:  Take exit 8 (Market Street).  Turn left at the light.  The hotel is located on the left, 0.5 mile from the intersection.

Traveling South on US 17:  Follow US-17 South into Wilmington.  The hotel is located on the left 0.5 mile from the intersection of US 17 and I-40.

Traveling North on US 17/ East on NC 74/76:  Follow US 17 North into Wilmington.  The hotel is located on the right approximately 4 miles after entering Wilmington.

Western Piedmont Community College, Moore Hall Auditorium
Traveling West on I-40:  From Hickory, take Exit 103 and turn right onto Burkemont Avenue (US 64).  Western Piedmont Community College is on the right.

Traveling East on I-40:  From Asheville, take Exit 103 and turn left onto Burkemont Avenue (US 64).  Cross the bridge over I-40.  Western Piedmont Community College is on the right.

Traveling on NC 18 from Lenoir:  Turn left onto S. Sterling Street.  Turn right at Burger King onto W. Fleming Drive.  At the N.C. School for the Deaf, turn left onto Burkemont Avenue.  Western Piedmont Community College is on the left at the second traffic light.

Traveling on NC 64 from Rutherfordton:  Driving into Morganton, cross over I-40.  Western Piedmont Community College is on the right, 1 block beyond I-40.

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

Attention:  All Providers

New Contact Information for Rate Setting Staff

The Professional Services and Behavioral Health section of DMA Rate Setting has relocated to One Bank of America Place.  The new contact information is below.

Last Name

First Name






































Main Line






For regular U.S. Mail the address remains unchanged:

Division of Medical Assistance
Rate Setting Section
2501 Mail Service Center
Raleigh  NC  27699-2501

For FedEx and UPS, please use the following physical address:

Division of Medical Assistance
Rate Setting Section
One Bank of America Plaza
421 Fayetteville Street, 9th Floor
Raleigh  NC  27601

We apologize for any inconvenience this may have caused you in reaching our section.  Please note all changes for future correspondences.

Rate Setting
DMA, 919-647-8170

Early and Periodic Screening, Diagnosis and Treatment and Applicability to Medicaid Services and Providers

Service limitations on scope, amount, duration, frequency, location of service, and other specific criteria stated in this publication may be exceeded or may not apply to recipients under 21 years of age if the provider's documentation shows that

This applies to both proposed and current limitations. Providers should review any information in this publication that contains limitations in the context of EPSDT and apply that information to their service requests for recipients under 21 years of age. A brief summary of EPSDT follows.

EPSDT is a federal Medicaid requirement (42 U.S.C. § 1396d(r) of the Social Security Act) that requires the coverage of services, products, or procedures for Medicaid recipients under 21 years of age if the service is medically necessary health care to correct or ameliorate a defect, physical or mental illness, or a condition [health problem] identified through a screening examination (including any evaluation by a physician or other licensed clinician).

This means that EPSDT covers most of the medical or remedial care a child needs to

Medically necessary services will be provided in the most economic mode possible, as long as the treatment made available is similarly efficacious to the service requested by the recipient's physician, therapist, or other licensed practitioner; the determination process does not delay the delivery of the needed service; and the determination does not limit the recipient's right to a free choice of providers.

EPSDT does not require the state Medicaid agency to provide any service, product, or procedure that is unsafe, ineffective, experimental, or investigational; that is not medical in nature; or that is not generally recognized as an accepted method of medical practice or treatment.

If the service, product, or procedure requires prior approval, the fact that the recipient is under 21 years of age does not eliminate the requirement for prior approval.

For important additional information about EPSDT, please visit the following websites:

Proposed Clinical Coverage Policies

In accordance with NCGS §108A-54.2, 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 Proposed Clinical Coverage Policies webpage.  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.

2009 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.

Tara R. Larson
Acting Director
Division of Medical Assistance
Department of Health and Human Services

Melissa Robinson
Executive Director
EDS, an HP Company

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