Use Standard Plan and Tailored Plan provider portals or Real-Time Eligibility Electronic Data Interchange Transactions 270/271.
Blog Entry List
An amended version of Clinical Coverage Policy 5A-3, Nursing Equipment and Supplies with an effective date of March 1, 2025, was posted to the NC Medicaid Clinical Coverage Policy web page.Summary of UpdatesIn the table Related Clinical Coverage Policies, added reference to clinical coverage policy 3D, Hospice Services.The terms ‘approval,’ ‘authorization’ and ‘prior authorization’ were changed to ‘prior approval’ for consistency throughout.
NC Medicaid added coverage for Healthcare Common Procedure Coding System (HCPCS) Code G0512 for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs)
Starting April 15, 2025, Pre-Admission Screening and Resident Review (PASRR) users must use Multi-Factor Authentication (MFA) via MyNCID to enhance security.
The PREP Act is extended to Dec. 31, 2029, expanding COVID-19 and flu vaccine access at pharmacy Point-of-Sale for ages 3 and older.
Effective Feb. 3, 2025, unless communicated otherwise by the Department
Information on Hurricane Helene Flexibilities, OPR Updates, MFA for All NCTracks Users, and more.
Includes Consolidated Appropriations Act Section 5121 Guidance.
Providers affected by Hurricane Helene have additional time to submit requests for services
Health plans are required to pay interest to providers if they fail to accurately pay or inappropriately deny a claim.
NC Medicaid updates mental health and substance use disorder policies.
NC Medicaid is aware of challenges and concerns from retro-enrollment changes, particularly their impact on claims and recoupments.
Vaya Health provides outreach, education and transition coordination.
To reduce the provider administrative burden during the enrollment application process, an important update has been made.