Topics Related to All Providers

NC Medicaid to Cover Imported Benzathine Benzylpenicillin (Extencilline): Billing Guidelines

Effective with date of service Jan. 16, 2024, NC Medicaid covers benzathine benzylpenicillin (Extencilline)

Bicillin® L-A Rates Increased Effective Feb. 1, 2024

This rate increase in the latest Physician Administered Drug Program fee schedule supports treating Medicaid members for Congenital Syphilis.

Clinical Coverage Policy updates for the 1115 Substance Use Disorder Waiver Demonstration

Policies to promulgate on May 1, 2024.

NC Medicaid Accepting Federally-Facilitated Marketplace Eligibility Determinations

NC Medicaid began accepting Federally-facilitated Marketplace Eligibility Determinations Feb. 1, 2024

NCDHHS Consolidates Local Management Entity/Managed Care Organizations Ahead of Tailored Plan Launch

Eastpointe and Trillium Health Resources have consolidated into one entity, and Sandhills Center has dissolved.

NC Medicaid Managed Care Provider Update – Jan. 30, 2024

Includes information on LME/MCO consolidation, Innovations and TBI waivers, federal fee increase, updates to NCTracks, Medicaid expansion and more.

NC Managed Care Capitation Rates – Updated Care Management Assumptions for Expansion Population

Includes rate considerations for Medicaid Expansion members effective Dec. 1, 2023.

Over-the-Counter COVID-19 Test for Home Use Pharmacy POS Coverage

CorDx, GoToKnow, FaStep COVID-19 AG Home Tests added to coverage.

Quality of Care Fact Sheets Available

Fact sheets provide key findings, trends, improvements and new programs

New Exclusion Sanction Questions to be added to Applications for Provider Enrollment

Beginning Jan. 28, 2024, five new additional exclusion sanction questions will be added.