This bulletin applies to NC Medicaid Direct and non-emergency medical transportation providers transporting NC Medicaid Fee-for-Service beneficiaries.
On Dec. 10, 2025, the State announced the reversal of Medicaid reimbursement rate reductions that took effect Oct. 1, 2025. North Carolina Medicaid is issuing this bulletin to advise non-emergency medical transportation (NEMT) providers on the phased approach being taken by NC Medicaid Direct to apply the NEMT reimbursement rates in effect as of Sept. 30, 2025, to NEMT services furnished on or after Oct. 1, 2025.
Prior Authorization Updates
Phase 1 – System Update
NC Medicaid has begun making system updates to re-instate NEMT reimbursement rates to those in effect on Sept. 30, 2025.
- Effective Dec. 17, 2025, any new NEMT prior authorizations submitted by counties to the Department will apply the NEMT reimbursement rates in effect Sept. 30, 2025.
- This update must occur before any claims-related adjustments can be made.
Phase 2 – Adjustment of Existing Prior Authorizations
Before providers submit claims and before NCTracks initiates claims processing, all NEMT prior authorizations impacted by the Oct. 1, 2025, rate reduction must be identified and adjusted to apply the NEMT reimbursement rate in effect as of Sept. 30, 2025.
- NCTracks will identify NEMT prior authorizations submitted on or after Oct. 1, 2025, through Dec. 16, 2025, that applied the 3% reduction to NEMT reimbursement rates in effect Sept. 30, 2025, and update those authorizations to apply the NEMT reimbursement rate in effect Sept. 30, 2025.
- If a county previously applied the 3% reduction to NEMT reimbursement rates in effect on Sept. 30, 2025, when submitting a prior authorization on or after Oct. 1, 2025, through Dec. 16, 2025, the county will be required to submit an updated authorization with the NEMT reimbursement rate in effect Sept. 30, 2025. Counties should not submit updated NEMT prior authorizations until they receive additional guidance from the Department.
If an NEMT provider has already submitted claims to NC Tracks for processing, claims for services furnished on or after Oct. 1, 2025, based on a prior authorization submitted between Oct. 1, 2025, and Dec. 16, 2025, will automatically be reprocessed by the Department once the prior authorization is identified and updated to apply the Sept. 30, 2025, rate.
To avoid duplicate or conflicting updates, NC Medicaid will allow NCTracks to complete updates to impacted prior authorizations submitted to the Department on or after Oct. 1, 2025, through Dec. 16, 2025, before counties begin submitting revised authorizations. The Department will provide guidance to counties on when to begin submitting updated NEMT prior authorizations.
Claims Processing
- Beginning Dec. 17, 2025, NC Tracks will no longer apply the 3% rate reduction to NEMT claims submitted for dates of service on or after Dec. 17, 2025.
- Beginning Dec 17, 2025, providers should confirm that the claim’s corresponding prior authorization reflects the correct amount before submitting claims.
Additional guidance will be shared as system updates are completed, and counties are notified to begin submitting updated authorizations.
NC Medicaid appreciates your patience and continued partnership as we work to ensure accurate reimbursement for NEMT services.