Topics Related to Medicaid Direct

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.

NC Medicaid to Remove Copays for HIV Antiretroviral Medications

Effective Nov. 1, 2023, NC Medicaid will remove all copay requirements for antiretroviral medications which decrease viral load in patients with HIV.

Hospital at Home Program Re-Launching for NC Medicaid

Hospital at Home Program Re-Launch: NC Medicaid will cover the Acute Hospital at Home Program starting Nov. 1, 2023.

NOTE: This Bulletin was revised on April 2, 2024 to correct an error. In the original version, published Sept. 27, 2023, it was stated that the Hospital at Home Program had a previous end date of March 31, 2021. Prior to relaunch, the previous end date was March 31, 2022, as corrected and explained below.