COVID-19 Guidance & Resources for Medicaid Providers

NC Medicaid is working with its federal, state and local partners to ensure Medicaid services continue to be delivered without interruption during the COVID-19 (coronavirus) outbreak. For answers to Medicaid policy-related COVID-19 questions, visit the COVID-19 Knowledge Center or email questions to medicaid.covid19@dhhs.nc.gov. Visit the NCDHHS COVID-19 webpage for the latest information about COVID-19, including testing resources and locations.

Updates (June 16, 2022)

While we do not know for certain when the public health emergency (PHE) will end, NC Medicaid wants to help beneficiaries and providers understand any potential impacts and steps they can take to be ready. 

Please continue to check this webpage and the Medicaid bulletin often for additional information as it is available. Providers are also encouraged to be familiar with the latest information for beneficiaries

Reinstatement of Provider Requirements

As the federal Public Health Emergency (PHE) comes to an end, providers will begin receiving reverification notices again. These notices will be sent to providers with approaching reverification due dates, as well as those whose reverification was suspended during the PHE. For more information, see Provider Reverification Requirements to be Reinstated.

Billing Requirement Modifications Due to COVID-19 Set to Expire 

When the end of the of the federal PHE approaches, NC Medicaid will be ending the temporary emergency flexibilities implemented in response to the federal government’s declaration of the COVID-19 PHE, including the disposition of three claims processing edits.

Edits 02437 and 02425 – “Service Facility Provider Invalid or Not Active on Dates of Service” and “Service Facility Provider Invalid or Not Active on Dates of Service. QMB Recipient” will change from pay and report to deny, as NPI validation will be required once the expiration date of the federal PHE is announced, which is anticipated to be mid-summer. These edits were relaxed during the pandemic in order to permit any individual practitioner to deliver services at locations not enrolled in NC Medicaid. Providers are encouraged to ensure service facility providers reported on claims are actively participating with NC Medicaid to avoid a claim denial.

Edit 07025 – “Rendering Provider Not Affiliated with Billing Provider” will change from pay and report to deny, as the requirement for an individual provider to affiliate with a billing organization will also be required once the expiration date of the federal PHE is announced, which is anticipated to be mid-summer. This edit was relaxed during the pandemic in order to permit any group to bill on behalf of an individual provider delivering services at another location/group practice with which the individual is not affiliated. Providers are encouraged to ensure Individual providers are corrected affiliated to Organizations billing on their behalf to avoid a claim denial.