This bulletin provides guidance on the 2026 – 2027 influenza season for NC Medicaid.
Topics Related to Medicaid Direct
Clarifications to providers on concurrent billing for Clinical Coverage Policy 8F.
Revisions to areas include definitions, eligibility and coverage criteria, specific criteria covered, transition and discharge planning and more.
NC Medicaid Managed Care Incremental Innovations Waiver DCW Rate Increases effective October 1, 2026, retroactive to July 1, 2026.
Effective July 1, 2026, NC Medicaid launched a targeted expansion of School-Based Services by Local Education Agencies.
The Centers for Medicare & Medicaid Services released the 2027 ICD-10 code list, Effective Oct. 1, 2026.
NC Medicaid has contracted with Health Management Systems to conduct Overpayment Recovery Reviews for Medicaid beneficiaries.
Updating the date format requirement for Hospital UR Plan submission.
Redistributing Previously Approved Shared Private Duty Nursing Hours Among Service Providers without a New CMS-485 or PDN Ordering Provider Order, Effective September 1, 2026
Beginning Nov. 1, 2026, Pharmacy Claims for controlled substances will be denied without an active certification on their NCTracks provider enrollment record.