Topics Related to Division of Health Benefits

Chiropractic Diagnosis Code Update for Claim Processing

New diagnosis codes now accepted for chiropractic services effective Aug. 1, 2024.

Important Update when Processing Community Alternatives Program Claims

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.

2024 Survey Reports Released

In recent months, NC Medicaid has published three survey reports that detail the experiences of beneficiaries and providers in North Carolina during 2024.

Update:​ ​Assessment Fee Adjustment for Intermediate Care Facilities for Intellectual Disabilities

Effective July 1, 2025, NC Medicaid adjusted the provider assessment rates.

Children and Families Specialty Plan – Primary Care Provider Beneficiary Choice Period Contracting Deadline

Primary Care Provider (PCP) contracting deadline for Beneficiary Choice Period is Sept. 1, 2025.

Adding Coverage of CPT Code 81515 – Xpert® Xpress Multiplex vaginal panel (MVP) that enables results within 60 minutes from a single specimen for Bacterial Vaginosis, Vulvovaginal Candidiasis and Trichomoniasis

Effective July 1, 2025, NC Medicaid will provide coverage for CPT Code 81515 – Xpert® Xpress MVP

Updated: NC Medicaid Behavioral Health Intellectual/Developmental Disabilities Tailored Plans Federally Qualified Health Center/Rural Health Clinics Prospective Payment System - Alternate Payment Methodology wrap payment methodology

Reimbursement methodology changes revised to begin with dates of service on or after Dec. 1, 2024.

Updated: Federally Qualified Health Centers and Rural Health Clinics Reimbursement Methodology Changes Approved

Standard Plans will reimburse the APM rate for claims with a date of service on or after Aug. 1, 2024.

Assessment Fee Adjustment for Intermediate Care Facilities for Intellectual/Developmental Disabilities

Effective July 1, 2025, NC Medicaid adjusted the provider assessment rates.

Credentialing Committee Bylaws Public Review Period Now Open

The North Carolina Department of Health and Human Services (NCDHHS), through General Dynamics Information Technology, Inc. (GDIT), will establish a Credentialing Committee to review files that contain flagged items for disposition of their enrollment, reenrollment and recredentialing applications and issues discovered through ongoing monitoring.  This will apply to all providers enrolling with: