Topics Related to Division of Health Benefits

NC Medicaid is providing additional information to providers about new federal prohibitions on certain providers.
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.
Effective July 1, 2025, NC Medicaid adjusted the provider per diem.
New diagnosis codes now accepted for chiropractic services effective Aug. 1, 2024.
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.
In recent months, NC Medicaid has published three survey reports that detail the experiences of beneficiaries and providers in North Carolina during 2024.
Effective July 1, 2025, NC Medicaid adjusted the provider assessment rates.
Primary Care Provider (PCP) contracting deadline for Beneficiary Choice Period is Sept. 1, 2025.