Topics Related to Medicaid Direct

Point-of-Sale (POS) Vaccine Reimbursement Updates

NC Medicaid will begin publishing the POS vaccine rate file in January of 2024

Requirements for Filling Prescriptions for Medicaid Beneficiaries: Reminder for the Expansion Population

NC Medicaid requires prescriptions to be ordered by Medicaid enrolled providers.

Standard Plans Add New Mid-Level Substance Use Treatment Services

NC Medicaid is adding mid-level substance use treatment services to Standard Plans effective October 3.

NC Medicaid Innovations Waiver Provider Rate Increase

Intended to Support Innovations Waiver Services Direct Care Worker Wage Increases

NC Medicaid Behavioral Health Services Rate Increases

Some services will receive rate increases effective Jan. 1, 2024

Legislated Medicaid Provider Rate Increases: Durable Medical Equipment and Ambulatory Surgical Centers

Updates on NC Medicaid programs that received legislative increases to service rates in the Current Operations Appropriations Act of 2023

Reprocessing of Outpatient Claims with Revenue Code 025x and 063x and Missing Required Data

Starting in November 2023, Standard Plans and Medicaid Direct will reprocess claims without appropriate documentation of required codes.

Maternity Coverage and Service Reimbursement Updates

NC Medicaid is implementing changes due to Session Law 2023-14 and to implement additional clinical best practices for maternity care.

NC Medicaid Direct Member Reassignment Process

Instructions for providers requesting removal of NC Medicaid Direct members from their patient panel

Update: Retroactive Disenrollment from NC Medicaid Managed Care

Providers should submit claims for dates of service that now fall in NC Medicaid Direct.