This bulletin provides guidance on the 2026 – 2027 influenza season for NC Medicaid.
Topics Related to Medicaid Managed Care
Clarifications to providers on concurrent billing for Clinical Coverage Policy 8F.
Revisions to areas include definitions, eligibility and coverage criteria, specific criteria covered, transition and discharge planning and more.
NC Medicaid Managed Care Incremental Innovations Waiver DCW Rate Increases effective October 1, 2026, retroactive to July 1, 2026.
The Centers for Medicare & Medicaid Services released the 2027 ICD-10 code list, Effective Oct. 1, 2026.
Updating the date format requirement for Hospital UR Plan submission.
Beginning Nov. 1, 2026, Pharmacy Claims for controlled substances will be denied without an active certification on their NCTracks provider enrollment record.
Reminders for NC Medicaid Managed Care, NC Medicaid Direct and Medicare.
Effective July 24, 2026, Basaglar® U-100 KwikPen® moved to Preferred status due to reported shortage of Lantus SoloStar pen.
The revised NC Medicaid 1915(i) assessment must be used starting Oct. 1, 2026, and includes a new companion guide.