This bulletin applies to NC Medicaid Managed Care Standard Plans.The North Carolina Department of Health and Human Services (NCDHHS) is releasing updated information about the care management component of capitation payments to NC Medicaid Managed Care Standard Plans effective July 1, 2024.
Topics Related to Bulletins
Effective retroactive to April 1, 2023, Z31.430 and Z31.440 will be covered diagnosis codes in NCTracks.
Training for Providers begins Friday, June 28. Additional dates are listed in this bulletin.
This bulletin applies to NC Medicaid Managed Care and NC Medicaid Direct.NC Medicaid now covers Point of Care rapid testing for Syphilis and HIV with an effective date of Jan. 1, 2024. This new coverage is being added to address the rise of syphilis and congenital syphilis cases that have re-emerged as a public health threat both nationally and in North Carolina.
Medicaid corrected the reimbursement issue and reprocessed claims for nerve conduction tests performed by physical therapists.
Provider Data Management / Credentialing Verification Organization (PDM/CVO) Solution New Launch Date of 2026.
Includes information on the New Launch Date for PDM/CVO, Healthy Opportunities Pilot, Provider Fact Sheets, Reverification Updates and more.
Includes information on the New Launch Date for PDM/CVO, Healthy Opportunities Pilot, Provider Fact Sheets, Reverification Updates and more.
Effective retroactive to Jan. 1, 2022, CPT code 80050 will no longer be reimbursed.
The PDM/CVO solution will consolidate provider data management and coordinate provider enrollment, credentialing, and ongoing data maintenance.
Providers should review Clinical Coverage Policy 2A-1 for information on Hospital Observation
Includes medical and pharmacy prior authorizations, out of network provider rates and rules, and primary care provider changes