Topics Related to Division of Health Benefits

Identifying Other Found Insurance for NC Medicaid Managed Care Members

Process change for Providers identifying Other Found Insurance for NC Medicaid Managed Care Members

Update to Billable Codes Used for Social Drivers of Health

Effective April 1, 2023, NC Medicaid is updating its guidance around billable codes for social drivers of health.

Durable Medical Equipment and Orthotic and Prosthetic Manually Priced Procedure Codes - Prior Authorization Update

A new prior authorization is required for beneficiaries returning to NC Medicaid Direct

2023 NC Medicaid Quality Symposium - Partnering for Performance

Register now for the diabetes self-management presentation on May 11 and adolescent immunization on May 16.

piflufolastat F18 Injection, for Intravenous Use (Pylarify®) HCPCS Code A9595 - Piflufolastat f-18, diagnostic, 1 millicurie: Billing Guidelines

Effective with date of service, Dec. 21, 2022, the NC Medicaid and NC Health Choice programs cover piflufolastat F18 injection

Local Management Entity/Managed Care Organization Enrollment Changes for April 1, 2023

Behavioral health prior authorizations effective April 1, 2023

NC Medicaid Managed Care Provider Update – March 22, 2023

Implementation of Tailored Plans, playbook update, Provider reverification, NC Health Choice move to Medicaid, NCTracks Provider records and more.

Lantus Update on NC Medicaid Preferred Drug List for NC Medicaid Direct

Lantus® SoloStar® / Vial will move to preferred on the NC Medicaid Preferred Drug List, effective March 24, 2023.

NC Health Choice Move to Medicaid: Timeline for Claims Adjudication and Process for Prior Approvals

As of April 1, 2023, all NC Health Choice beneficiaries with active eligibility will be moved to Medicaid.

NC Medicaid Managed Care Capitation Rates – Care Management Assumptions

Updated information about the assumptions underlying the care management component of capitation payments to Standard Plans