Effective July 1, 2026, local education agency claims submitted to NCTracks must include the individual ordering, prescribing or referring and rendering provider’s National Provider Identifier.
Blog Entry List
With the launch of the Children and Family Specialties Plan (CFSP), NC Medicaid enacted policy levers to promote continuity of care for CFSP members and ease the administrative burden on providers. For more information, see the Provider Bulletin from Oct. 13, 2025.The following policies will expire June 30, 2026. These include:
On April 20, 2027, the Innovations Waiver “Community/Behavioral Health” Service under taxonomy 251S00000X will be end-dated on provider records.
Effective May 2, 2026, use of the pharmacy National Provider Identifier in the prescriber field on Point-of-Sale claims for all protocol drugs will no longer be allowed.
Local Health Departments will continue to offer Care Management for At Risk Children and Care Management for High-Risk Pregnancy services to Medicaid beneficiaries, with Per Member Per Month payments remaining in effect, both through Dec. 31, 2026.
Prime Therapeutics is the New Pharmacy Benefit Administrator for NC Medicaid Direct Point of Sale Pharmacy, effective May 2, 2026.
These revisions are a result of the Current Dental Terminology CDT-2026 American Dental Association (ADA) code updates.
These revisions are a result of the Current Dental Terminology CDT-2026 American Dental Association (ADA) code updates.
Information about a new Provider Directory API, recent provider communications, upcoming webinars and more.
Action Required: Providers with Active 251S00000X Taxonomy must select New Service and Report National Accreditation.
Action Required: Providers with Active 251S00000X Taxonomy must select Service and meet national accreditation requirements within one year.
Modifier CR should only be appended to procedure codes when services are directly related to a Federal or State-declared emergency or disaster.
The Centers for Medicare & Medicaid Services has released 80 new ICD-10-PCS codes, Effective April 1, 2026.
Following stakeholder engagement and review of departmental priorities, NC Medicaid will not be implementing the Advanced Medical Home (AMH) Standardized Performance Incentive Program (SPIP) at this time.
This bulletin updates the previously published NC Medicaid Direct Pharmacy Benefits Administrator Provider Transition Overview and Webinars bulletin.