Key milestones, playbook updates, verifying eligibility, provider reverification, provider records, behavioral health services transition and more
Blog Entry List
Providers should contact the PHPs and Provider Ombudsman to resolve issues.
Attention Standard Plans/Tailored Plans/HHA Exchange/CareBridge and Healthy Blue
Updates to Clinical Coverage Policy 1A-5 with an effective date of Sept. 2, 2022.
What services are available, in which regions, and how providers can refer patients.
Updates on Tailored Plan criteria review, eligibility criteria, enrollment and health care options, and resources for Beneficiaries and Providers.
The adjudication of some prior approvals will be performed by GDIT Fiscal Agent Operations Reviewers instead of clinical reviewers at NC Medicaid
Providers shall not bill a NC Medicaid beneficiary for services furnished to a beneficiary who the provider has accepted as a Medicaid patient.
Effective July 1, 2022, Medicaid and NC Health Choice cover kit for the preparation of Gallium Ga 68 gozetotide injection
NC Medicaid is working with Standard Plans to create easier pathways for providers to reach Standard Plans and resolve panel issues.
NCDHHS will implement an Electronic Visit Verification system for Home Health Care services starting with a soft launch Jan. 1, 2023, and a hard launch April 1, 2023. This complies with the 21st Century Cures Act.
Provider manual update, guidance on position qualifications, phased assignment approach for Tailored Care Management providers and more.
Service field location effective date change from Oct. 5, 2022, to Jan. 1, 2023
NC Medicaid is sharing a list of member counts for Advanced Medical Home practices affiliated with Tailored Plans
Effective June 22, 2022, Medicaid and NC Health Choice cover Nalmefene hydrochloride injection (Revex™)