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Managed Care/Payer Issues
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NC Medicaid Claims to be Audited during 2010
This year, North Carolina is required to participate in an administrative and medical audit of its Medicaid and State Children’s Health Insurance Program (SCHIP) programs as part of the national Payment Error Rate Measurement (PERM) program implemented by CMS.
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Medicaid to Implement a Preferred Drug List
The North Carolina Medicaid Program has announced plans to implement a Preferred Drug List (PDL) effective March 15. The General Assembly authorized the creation of a PDL during the 2009 session as a […]
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UHC Expands Successful Physician Advocate Program
In recent years UnitedHealthcare (UHC) had been rated among the worst insurers in NC in terms of provider satisfaction. So in 2008, UHC targeted NC as one of eight states […]
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UHC Revises Claim Reconsideration Form
UnitedHealthcare has revised its Claim Reconsideration Request form for contracting physicians, hospitals, and other health care professionals. The minor changes are meant to clarify that claim reconsideration is not part […]
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Health Care Community Comments on Medicaid Provider Agreement
The NC Division of Medical Assistance (DMA) recently sought feedback from provider representatives about concerns over the new Medicaid provider agreement. The North Carolina Medical Society, in coordination with other organizations, has submitted a written proposal of suggested changes to the agreement.
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CMS Designates Advanced Imaging Accrediting Bodies
The Medicare Improvements for Patients and Providers Act of 2008 requires providers who wish to continue providing advanced imaging services to Medicare patients to obtain accreditation from one of three national organizations by January 1, 2012.
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BCBSNC Announces Changes Regarding Restricted-Access Drugs
Blue Cross Blue Shield of North Carolina (BCBSNC) is sending three separate letters to physicians about changes in the administrative process related to selected hypnotic agents, selective serotonin reuptake inhibitors, […]
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New Codes Prompt BCBSNC to Update Medical Policies
Blue Cross Blue Shield of North Carolina has informed the NCMS of updated medical policies for January 5, 2010 and January 19, 2010, and the Notification of Policy Revisions Effective […]
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BCBS Association Extends Activation Deadline for Free Credit Monitoring Service
Providers continue to take advantage of the Blue Cross Blue Shield Association’s (BCBSA) offering of one year free credit monitoring service. The offer followed a security breach in August 2009 […]
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PractEssentials Offers Lunchtime Lesson on New Consulting Code Changes
The North Carolina Medical Group Managers Association and the NCMS Foundation PractEssentials are jointly hosting a webinar on Thursday, February 11, 2010, 12:00 noon – 1:00 pm, on 2010 Consulting […]
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