An out-of-date NCTracks provider record jeopardizes continued NCDHHS program participation.
Topics Related to Division of Health Benefits
For NC Medicaid and Division of Mental Health, Developmental Disabilities, and Substance Use Services (DMHDDSUS) State Funded Behavioral Health Providers.
NOTE: This change applies only to NC Medicaid Direct beneficiaries. There is no impact to beneficiaries enrolled in NC Medicaid Managed Care.OverviewThe North Carolina Department of Health and Human Services (NCDHHS) is transitioning Pharmacy Benefit Administrator (PBA) services for NC Medicaid Direct. Beginning May 2, 2026, Prime Therapeutics State Government Solutions LLC (Prime) will serve as the PBA for NC Medicaid Direct pharmacy claims.
Flexibilities extended through Feb. 6, 2026, for NC Medicaid beneficiaries due to additional Winter Storm weather.
Information on Required Provider Disclosures, Children and Families Specialty Plan Flexibilities, Case Manager/Care Coordinators Updates and more.
Flexibility extended to Jan. 30, 2026, for NC Medicaid beneficiaries due to Winter Storm.
Assessment rates were affected by the implementation and subsequent reversal of the Oct. 1, 2025, per diem rate reductions.
Flexibilities effective Jan. 23, 2026, to Jan. 26, 2026, for NC Medicaid beneficiaries due to Winter Storm.
This bulletin corrects Current Procedure Terminology (CPT) code tables initially published Dec. 30, 2025.
Effective Jan. 1, 2026, NC Medicaid has amended Clinical Coverage Policy 1T-2.