Topics Related to Bulletins

Adding Coverage for Point of Care Rapid testing for Syphilis and HIV

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. 

Adding Physical Therapists to Electrodiagnostic Studies Correction

Medicaid corrected the reimbursement issue and reprocessed claims for nerve conduction tests performed by physical therapists.

NC Medicaid Managed Care Provider Update – June 20, 2024

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.

Terminating Coverage of CPT Code 80050 – General Health Panel

Effective retroactive to Jan. 1, 2022, CPT code 80050 will no longer be reimbursed.

Provider Data Management / Credentialing Verification Organization Solution New Launch Date of 2026

The PDM/CVO solution will consolidate provider data management and coordinate provider enrollment, credentialing, and ongoing data maintenance.

Reminder on Hospital Observation Policy

Providers should review Clinical Coverage Policy 2A-1 for information on Hospital Observation

Flexibilities to Ease Provider Administrative Burden at Tailored Plan Launch

Includes medical and pharmacy prior authorizations, out of network provider rates and rules, and primary care provider changes

Nicotine Replacement Therapy Protocol Reimbursement Effective Aug. 1, 2024

Usage of the Nicotine Replacement Therapy Protocol is Eligible for Clinical Services Reimbursement to Pharmacies.

Tailored Care Management Options for Transitions to Community Living Medicaid Members

Members may now select to receive Tailored Care Management from a provider with Transition to Community Living Distinction.

Value-Based Payment Update: Making Care Primary (MCP) Model Alignment in NC Medicaid

Feedback Requested on Proposed Approach