Topics Related to Division of Health Benefits
Updates to Clinical Coverage Policy 1A-5 with an effective date of Sept. 2, 2022.
What services are available, in which regions, and how providers can refer patients.
Updates on Tailored Plan criteria review, eligibility criteria, enrollment and health care options, and resources for Beneficiaries and Providers.
Providers shall not bill a NC Medicaid beneficiary for services furnished to a beneficiary who the provider has accepted as a Medicaid patient.
The adjudication of some prior approvals will be performed by GDIT Fiscal Agent Operations Reviewers instead of clinical reviewers at NC Medicaid
Service field location effective date change from Oct. 5, 2022, to Jan. 1, 2023
NC Medicaid is working with Standard Plans to create easier pathways for providers to reach Standard Plans and resolve panel issues.
Effective July 1, 2022, Medicaid and NC Health Choice cover kit for the preparation of Gallium Ga 68 gozetotide injection
Provider manual update, guidance on position qualifications, phased assignment approach for Tailored Care Management providers and more.
NC Medicaid is sharing a list of member counts for Advanced Medical Home practices affiliated with Tailored Plans