Topics Related to Medicaid Managed Care

The five-year cost of dispensing survey has been completed for North Carolina pharmacies.
Includes medical and pharmacy prior authorizations, out-of-network provider rates and rules and primary care provider changes.
The fact sheet outlines the key responsibilities of practices receiving auto-assigned members.
Effective Oct. 1, 2025, NC Medicaid will no longer cover the prescription drug Xifaxan (Rifaximin).
Providers can no longer bill NC Medicaid for Hospital at Home for dates of service on or after Oct. 1, 2025.
Flexibilities effective Sept. 26, 2025, for NC Medicaid beneficiaries due to Hurricane Humberto and Tropical Storm Invest 94L (Potential Imelda).
Current Procedural Terminology (CPT) code 99177, Screening of Eye with Special Instrument Onsite Analysis is separately reimbursable effective Nov. 1, 2024.
NC Medicaid is providing additional information to providers about new federal prohibitions on certain providers.
Join NC Medicaid and the Health Plans on October 8 for the virtual quality forum
NC Medicaid is providing additional information to providers about new federal prohibitions on certain providers.