Topics Related to Medicaid Direct

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.

Expanding Pilot Eligibility to Members in NC Medicaid Direct in Pilot Regions

Billing Requirements for Medicaid Direct Providers

Look for details on training in June related to these changes.

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

Providers should work with their Medicaid beneficiary’s health plan and Tailored Care Manager to transition the members to 1915(i) services.