Concurrent Child and Adolescent Day Treatment and Residential Treatment Services remain subject to medical necessity and non-duplication requirements.
Topics Related to Medicaid Direct
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.
Prime Therapeutics is the New Pharmacy Benefit Administrator for NC Medicaid Direct Point of Sale Pharmacy, effective May 2, 2026.
These revisions are a result of the Current Dental Terminology CDT-2026 American Dental Association (ADA) code updates.
These revisions are a result of the Current Dental Terminology CDT-2026 American Dental Association (ADA) code updates.
Action Required: Providers with Active 251S00000X Taxonomy must select New Service and Report National Accreditation.
Modifier CR should only be appended to procedure codes when services are directly related to a Federal or State-declared emergency or disaster.