Updates to Clinical Coverage Policy 1A-5 with an effective date of Sept. 2, 2022.
Blog Entry List
Updates on Tailored Plan criteria review, eligibility criteria, enrollment and health care options, and resources for Beneficiaries and Providers.
What services are available, in which regions, and how providers can refer patients.
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.
NC Medicaid is working with Standard Plans to create easier pathways for providers to reach Standard Plans and resolve panel issues.
Effective July 1, 2022, Medicaid and NC Health Choice cover kit for the preparation of Gallium Ga 68 gozetotide injection
Provider manual update, guidance on position qualifications, phased assignment approach for Tailored Care Management providers and more.
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.
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™)
The PDAP Medicaid fee schedule requires multiple rate updates
Effective June 21, 2022, Medicaid and NC Health Choice cover Vutrisiran injection, for subcutaneous use (Amvuttra).
Effective June 22, 2022, Medicaid and NC Health Choice cover Risankizumab-rzaa Injection, for intravenous use (Skyrizi).