Topics Related to Medicaid Managed Care

Out-of-State Enrolled Pharmacies List Now Posted & Updated Daily on NCTracks

This bulletin applies to NC Medicaid Direct and NC Medicaid Managed Care. 

NC Medicaid is committed to ensuring continued access to care for NC Medicaid beneficiaries. As a service to both NC Medicaid beneficiaries and providers, NCTracks has created a webpage listing of all enrolled out-of-state (OOS) pharmacies, categorized by state.  

Quality Strategy Available for Public Comment

Comments accepted through Jan. 6, 2024.

Tailored Care Management Temporary Rate Extension

NC Medicaid will continue the current Tailored Care Management temporary payment rate of $343.97 statewide through June 30, 2025.

NC Medicaid Managed Care Provider Update – November 27, 2024

Includes information on Change of Ownership Requirement, Upcoming Webinars, and more.

Revised Reimbursement Methodology for Individuals Living in Congregate Settings Administered by Personal Care Service Providers

Effective Jan. 1, 2025, the unit of reimbursement will change from a 15-minute increment to a daily per diem.

COVID-19 Vaccine and Reimbursement Guidelines for 2024-2025 for NC Medicaid

Includes information on vaccine reimbursement, billing, counseling coverage and Immunization Program/Vaccines for Children

Health Plan Interest for Provider Claims

Health plans are required to pay interest to providers if they fail to accurately pay or inappropriately deny a claim.

Retainer Payments for Home and Community-Based Service Providers Impacted by Hurricane Helene

For providers unable to provide services under an active, approved service plan due to the impacts of Hurricane Helene.

2023 CAHPS Survey Report Released

This survey provides a national standard for assessing beneficiaries’ health care experience.

Influenza Vaccine and Reimbursement Guidelines for 2024-2025 for NC Medicaid

This bulletin applies to both NC Medicaid Direct and NC Managed Care health plans.

Vaccine strains for the 2024–25 influenza vaccines were selected by the Food and Drug Administration’s Vaccines and Related Biologic Products Advisory Committee (VRBPAC) based on WHO’s recommended Northern Hemisphere 2024–25 influenza vaccine composition. For details on the 2024-2025 influenza vaccines, visit the Centers for Disease Control (CDC) Flu Season web page.