Topics Related to Medicaid Direct
The deadlines stated in this bulletin replace those previously published in the Post-Enrollment National Accreditation Update bulletin April 16, 2026.
Adverse determination letters generated through NCTracks have been updated to reflect these changes.
Beginning Jan. 1, 2027, all current maternity service codes, including global billing, will be deleted from the fee schedule.
Effective July 1, 2026, NC Medicaid has amended Clinical Coverage Policy 10A, Outpatient Specialized Therapy Services.
On Dec. 31, 2026, the NC Integrated Care for Kids (InCK) pilot program will conclude. This applies to NC Medicaid Direct and NC Medicaid Managed Care.
Concurrent Child and Adolescent Day Treatment and Residential Treatment Services remain subject to medical necessity and non-duplication requirements.
A new prior authorization is required for NC Medicaid Managed Care beneficiaries returning to NC Medicaid Direct.
This bulletin clarifies NC Medicaid billing requirements to ensure proper submission of laboratory services.
Effective July 1, 2026, local education agency claims submitted to NCTracks must include the individual ordering, prescribing or referring and rendering provider’s National Provider Identifier.
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.