Topics Related to All Providers

Providers should review Clinical Coverage Policy 2A-1 for information on Hospital Observation
Usage of the Nicotine Replacement Therapy Protocol is Eligible for Clinical Services Reimbursement to Pharmacies.
Members may now select to receive Tailored Care Management from a provider with Transition to Community Living Distinction.
Expanding Pilot Eligibility to Members in NC Medicaid Direct in Pilot Regions
States must revalidate the enrollment of all providers at least every five years to ensure the information on record is accurate and current.
Withdrawal Management Policies Delayed
The audit will sample fee-for-service claims collected for a full year – July 1, 2024, through June 30, 2025.
Recent State Plan Amendment outlines duties of a responsible third party
New separately reimbursable CPT codes in the ambulatory surgery setting