Topics Related to Division of Health Benefits

Updates to NC Medicaid Payments to Prohibited Entities

NC Medicaid is providing additional information to providers about new federal prohibitions on certain providers.

Important Updates to Prior Authorization and Claims Requirements for Optical Services

Based on prior authorization and claim changes, optical providers (ophthalmologists, optometrists and opticians) should review NCTracks enrollment status to ensure there is an individual optical provider enrolled at the practice location where the visual aids are being ordered.

​​​Per Diem Increase for Community Based Intermediate Care Facilities for Intellectual Disabilities

Effective July 1, 2025, NC Medicaid adjusted the provider per diem.

Chiropractic Diagnosis Code Update for Claim Processing

New diagnosis codes now accepted for chiropractic services effective Aug. 1, 2024.

Important Update when Processing Community Alternatives Program Claims

Effective July 3, 2025, claims submitted without the ordering or referring physician National Provider Identifier will be adjudicated with a pay status for the Community Alternatives Program for Children and Disabled Adults.

2024 Survey Reports Released

In recent months, NC Medicaid has published three survey reports that detail the experiences of beneficiaries and providers in North Carolina during 2024.

Update:​ ​Assessment Fee Adjustment for Intermediate Care Facilities for Intellectual Disabilities

Effective July 1, 2025, NC Medicaid adjusted the provider assessment rates.

Children and Families Specialty Plan – Primary Care Provider Beneficiary Choice Period Contracting Deadline

Primary Care Provider (PCP) contracting deadline for Beneficiary Choice Period is Sept. 1, 2025.

Adding Coverage of CPT Code 81515 – Xpert® Xpress Multiplex vaginal panel (MVP) that enables results within 60 minutes from a single specimen for Bacterial Vaginosis, Vulvovaginal Candidiasis and Trichomoniasis

Effective July 1, 2025, NC Medicaid will provide coverage for CPT Code 81515 – Xpert® Xpress MVP

Updated: NC Medicaid Behavioral Health Intellectual/Developmental Disabilities Tailored Plans Federally Qualified Health Center/Rural Health Clinics Prospective Payment System - Alternate Payment Methodology wrap payment methodology

Reimbursement methodology changes revised to begin with dates of service on or after Dec. 1, 2024.