Heather Cook Skelton
Attorney at Law

As new and challenging Medicaid initiatives are being announced, physician practices are beginning to respond. The need, usefulness and effect on patient care are of top concern. In response to massive budgetary shortfalls this year, DHHS has been directed to initiate a number of changes, including the following:

• Imaging Preauthorization: The 8/21/2009 announcement that “high tech images” including MRI, CT, PET scans and ultrasounds will require prior authorization from MedSolutions starting 10/19/2009. Watch for the September 2009 Medicaid Bulletin for more details.
• Credentialing Applications: New credentialing applications were mailed by CSC to all physicians who had not been credentialed within the previous 14 months. Although it does not apply to earlier mailings, future applications will be available on-line, and practices will be able to use the on-line application for enrollment, re-enrollment, report a change in ownership, change the group name/tax name, report a change in tax number, or to add services.
• Provider Enrollment Fee: Collection of a $100 enrollment fee from new physicians, and from all providers at re-enrollment every three years, effective 9/1/2009.
• Medicaid ID Cards: Effective immediately, Medicaid will issue only one Medicaid ID card per year to each recipient. They will be printed on gray card stock.
• Electronic Claims Submission/Recipient Eligibility Verification Web Tool:Eligibility will be available online, including current eligibility, Medicaid benefit category, Medicare participation, Carolina ACCESS participation, transfer of asset information and other insurance information.

The North Carolina Medical Society encourages physicians to them with the problems they are facing during this Medicaid transition period.