Topics Related to Bulletins

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:  

Quarterly Provider Update – Summer 2025

Information on Provider Ombudsman, Children and Families Specialty Plan and Upcoming Credentialing Changes.

Tailored Care Management Temporary Rate Extension Ended

The Tailored Care Management payment rate is $294.86 effective July 1, 2025.

Assessment Fee Adjustment for Skilled Nursing Facility Providers

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