Topics Related to Division of Health Benefits
Effective July 1, 2026, NC Medicaid has amended Clinical Coverage Policy 10A, Outpatient Specialized Therapy Services.
On Dec. 31, 2026, the NC Integrated Care for Kids (InCK) pilot program will conclude. This applies to NC Medicaid Direct and NC Medicaid Managed Care.
Concurrent Child and Adolescent Day Treatment and Residential Treatment Services remain subject to medical necessity and non-duplication requirements.
A new prior authorization is required for NC Medicaid Managed Care beneficiaries returning to NC Medicaid Direct.
This bulletin clarifies NC Medicaid billing requirements to ensure proper submission of laboratory services.
Effective July 1, 2026, local education agency claims submitted to NCTracks must include the individual ordering, prescribing or referring and rendering provider’s National Provider Identifier.
With the launch of the Children and Family Specialties Plan (CFSP), NC Medicaid enacted policy levers to promote continuity of care for CFSP members and ease the administrative burden on providers. For more information, see the Provider Bulletin from Oct. 13, 2025.
The following policies will expire June 30, 2026. These include:
On April 20, 2027, the Innovations Waiver “Community/Behavioral Health” Service under taxonomy 251S00000X will be end-dated on provider records.
Effective May 2, 2026, use of the pharmacy National Provider Identifier in the prescriber field on Point-of-Sale claims for all protocol drugs will no longer be allowed.
Local Health Departments will continue to offer Care Management for At Risk Children and Care Management for High-Risk Pregnancy services to Medicaid beneficiaries, with Per Member Per Month payments remaining in effect, both through Dec. 31, 2026.