This bulletin applies to NC Medicaid Direct and NC Medicaid Managed Care.
NC Medicaid Managed Care
If eligibility is retroactively updated to one of the NC Medicaid Managed Care health plans from NC Medicaid Direct or from a different NC Medicaid Managed Care health plan, providers must reach out to the new plan to determine how claims should be submitted.
Medicare
Please refer to the Sept. 17, 2024, Provider Bulletin Processing Claims Affected by Medicare Retroactive Enrollment.
NC Medicaid Direct
This is a reminder for providers regarding the appropriate steps to take when a previously paid claim is recouped by an NC Medicaid Managed Care health plan due to retro-eligibility back to NC Medicaid Direct.
When a recoupment occurs, providers must ensure the claim is submitted to NC Medicaid Direct within 180 days of the recoupment date. All submissions must include documentation showing:
- Proof of the recoupment from the NC Medicaid Managed Care health plan
- Verification that the original claim was submitted on time
Providers may use the job aid “Provider Adjustments, Time Limit Overrides, and Medicare Overrides” as a resource for completing these submissions in NCTracks. These requests may be submitted electronically.
Resources
Please see the Health Plan Contracts section on the NC Medicaid Health Plans webpage.
Contact
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This page was last modified on 08/10/2026