Blog Entry List
Note: This bulletin is replaced by NC Health Choice Move to Medicaid: Timeline for Claims Adjudication and Process for Prior Approvals.
Includes Pharmacy Point of Sale, Physician Administered Drug Program and Outpatient Hospital Pharmacy
The insulin glargine vial and insulin glargine Solostar® will be added as Preferred on the NC Medicaid Preferred Drug List, effective Jan. 27, 2023.
Point-of-sale (POS) billing for FDA-authorized over-the-counter (OTC) COVID-19 tests dispensed for use by NC Medicaid beneficiaries in a home setting remains in effect for NC Medicaid Direct and all five managed care plans.
Vaccine Immunization Claims Can Be Submitted on Pharmacy Claims for NC Medicaid Direct Beneficiaries
Effective Dec. 1, 2022, pharmacy providers who administer immunizations at pharmacies may bill NC Medicaid Direct for vaccines on pharmacy claims
This error occurred when the LARC was filled by a point-of-sale pharmacy and inserted by the provider in the clinic.
Certain vaccinations must be offered to Medicaid-eligible beneficiaries without a co-pay charge.
Ventolin® HFA will shift from Non-Preferred to Preferred on the Preferred Drug List (PDL), effective Sept. 23, 2022.
The PDAP Medicaid fee schedule requires multiple rate updates
Pharmacy Point of Sale claims for members enrolled Tailored Plans will be managed by NCTracks when Tailored Plans launch through March 31, 2023.
Effective May 1, 2022, claims with Rev Code 025x and 063x will deny without appropriate documentation of NDC and HCPCS codes.
Approved for treatment of mild to moderate COVID-19
Effective Feb. 1, 2022, Clinical Pharmacist Practitioner taxonomy code 1835P0018X will be allowed to bill and be reimbursed.
Revisions to previous scope of authorization