Use Standard Plan and Tailored Plan provider portals or Real-Time Eligibility Electronic Data Interchange Transactions 270/271.
Topics Related to Medicaid Direct
An amended version of Clinical Coverage Policy 5A-3, Nursing Equipment and Supplies with an effective date of March 1, 2025, was posted to the NC Medicaid Clinical Coverage Policy web page.Summary of UpdatesIn the table Related Clinical Coverage Policies, added reference to clinical coverage policy 3D, Hospice Services.The terms ‘approval,’ ‘authorization’ and ‘prior authorization’ were changed to ‘prior approval’ for consistency throughout.
This bulletin describes the changes required under CAA 5121 as well as reminders on the suspension of benefits during incarceration.
The PREP Act is extended to Dec. 31, 2029, expanding COVID-19 and flu vaccine access at pharmacy Point-of-Sale for ages 3 and older.
Effective Feb. 3, 2025, unless communicated otherwise by the Department
Includes Consolidated Appropriations Act Section 5121 Guidance.
Providers affected by Hurricane Helene have additional time to submit requests for services
NC Medicaid updates mental health and substance use disorder policies.
NC Medicaid is aware of challenges and concerns from retro-enrollment changes, particularly their impact on claims and recoupments.