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NC Medicaid Deductibles and Private Duty Nursing

Tuesday, October 22, 2019

Unpaid medical bills and current medical expenses count toward NC Medicaid applicants’ deductibles. Private Duty Nursing (PDN) services qualify as a medical expense and may be used toward meeting this deductible. For more information about qualifying expenses, please refer to the Medicaid Deductible page of the NC Medicaid website.

Medicaid cannot grant prior authorization (PA) for PDN services until an applicant becomes Medicaid eligible. If PDN services are used to meet the Medicaid deductible, no PA for PDN is required until Medicaid eligibility has been established. It is the responsibility of the PDN provider to verify Medicaid eligibility and submit a PA request for PDN to NCTracks. Provided that the Medicaid eligible beneficiary meets clinical eligibility for PDN, retroactive approval is available for up to 10 business days.

Author: 
GDIT, (800) 688-6696