This bulletin provides guidance to providers caring for NC Medicaid beneficiaries also enrolled in Marketplace coverage through HealthCare.gov.
Topics Related to Division of Health Benefits
Effective Aug. 1, 2024, Medicaid will require a primary diagnosis of spinal subluxation for NC Medicaid Direct claims.
Standard Plans will begin to reimburse the APM rate for claims with a date of service on or after Aug. 1, 2024.
Providers need to submit new prior authorizations (PA) for services subject to 42 Code of Federal Regulations (CFR) Part II.
Effective Aug. 1, 2024, NC Medicaid will cover obesity management medications for beneficiaries 12 years of age and older.
Effective Aug. 1, 2024, over the counter oral contraceptive Opill will be available without a prescription, at no cost.
Effective Dec. 1, 2023, updates increased treatment visit limits for beneficiaries aged 21 and older. The home health ordering practitioner reference was also updated.
Includes information on new policies, tools and guidance, as well as several clarifications
Effective June 1, 2024, CPT codes are newly eligible for coverage.
Impacts NC Medicaid Managed Care Standard Plans, Behavioral Health and Intellectual/Developmental Disabilities Tailored Plans and LME/MCOs.