Topics Related to Medicaid Direct

Usage of the Nicotine Replacement Therapy Protocol is Eligible for Clinical Services Reimbursement to Pharmacies.
Expanding Pilot Eligibility to Members in NC Medicaid Direct in Pilot Regions
Billing Requirements for Medicaid Direct Providers
Look for details on training in June related to these changes.
Withdrawal Management Policies Delayed
The audit will sample fee-for-service claims collected for a full year – July 1, 2024, through June 30, 2025.
Recent State Plan Amendment outlines duties of a responsible third party
New separately reimbursable CPT codes in the ambulatory surgery setting
Providers should work with their Medicaid beneficiary’s health plan and Tailored Care Manager to transition the members to 1915(i) services.
The Centers for Medicare & Medicaid Services has approved State Plan Amendments to revise reimbursement methodology.