Topics Related to Division of Health Benefits
In recent months, NC Medicaid has published three survey reports that detail the experiences of beneficiaries and providers in North Carolina during 2024.
Effective July 1, 2025, NC Medicaid adjusted the provider assessment rates.
Primary Care Provider (PCP) contracting deadline for Beneficiary Choice Period is Sept. 1, 2025.
Effective July 1, 2025, NC Medicaid will provide coverage for CPT Code 81515 – Xpert® Xpress MVP
Reimbursement methodology changes revised to begin with dates of service on or after Dec. 1, 2024.
Standard Plans will reimburse the APM rate for claims with a date of service on or after Aug. 1, 2024.
Effective July 1, 2025, NC Medicaid adjusted the provider assessment rates.
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:
Information on Provider Ombudsman, Children and Families Specialty Plan and Upcoming Credentialing Changes.
The Tailored Care Management payment rate is $294.86 effective July 1, 2025.