Topics Related to All Providers

Provider Categorical Risk Level Adjustment

Categorical Risk Level Subject to Bump-Up for Certain Providers.

NC Medicaid Off-Cycle Change to the Preferred Drug List Due to Lantus SoloStar Pen Shortage

Effective July 24, 2026, Basaglar® U-100 KwikPen® moved to Preferred status due to reported shortage of Lantus SoloStar pen.

Utilization Management by NC Medicaid Managed Care Health Plans – August 2026

This bulletin replaces in full the December 2025 Utilization Management by Managed Care Plans Aligned with Food and Drug Administration Labeling bulletin.

Sixth Annual Virtual Statewide Standard Plan Quality Forum

NC Medicaid, in collaboration with the four NC Medicaid Managed Care Standard Plans, will host the Sixth Annual Virtual Statewide Quality Forum on Wednesday, Oct. 14, 2026, from 11 a.m. to 1 p.m.

Clinical Coverage Policy Update 1A-20 Sleep Studies and Polysomnography Services

Amendments to Clinical Coverage Policy 1A-20, expanding medical necessity criteria and updating coverage for sleep studies and polysomnography services are effective July 1, 2026.

Change to Hearing Office Fax Number and a Copy of Provider’s Adverse Action Now Required

Adverse determination letters generated through NCTracks have been updated to reflect these changes.

Key Updates to NC Medicaid Clinical Coverage Policy 10A, Outpatient Specialized Therapy Services

Effective July 1, 2026, NC Medicaid has amended Clinical Coverage Policy 10A, Outpatient Specialized Therapy Services.

NC Medicaid Update on the Care Management for At-Risk Children and Care Management for High-Risk Pregnancy Programs

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.

Attention: All Dental Providers Revisions to Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Service D9248

These revisions are a result of the Current Dental Terminology CDT-2026 American Dental Association (ADA) code updates.

Attention: All Dental Providers: Revisions to Anesthesia and Sedation Services

These revisions are a result of the Current Dental Terminology CDT-2026 American Dental Association (ADA) code updates.