Medicaid Bulletin

Medicaid Bulletin Monthly Digest

Medicaid Bulletin Archive

Articles beginning January 2018 are available in the blog format.

Process Change for NC Medicaid Direct Private Duty Nursing Prior Authorizations
Look for details on training in June related to these changes.
NC Medicaid Long Term Services and Supports to hold Provider Forum
Forum to be held Tuesday, June 25 in Concord.
Behavioral Health Clinical Coverage Policy Updates
Withdrawal Management Policies Delayed
Payment Error Rate Measurement Audit for Reporting Year 2026
The audit will sample fee-for-service claims collected for a full year – July 1, 2024, through June 30, 2025.
Third-Party Recovery Rules Effective Jan. 1, 2024
Recent State Plan Amendment outlines duties of a responsible third party
Annual Ambulatory Surgery Center Update
New separately reimbursable CPT codes in the ambulatory surgery setting
Federally Qualified Health Centers and Rural Health Clinics Reimbursement Methodology Changes Approved
The Centers for Medicare & Medicaid Services has approved State Plan Amendments to revise reimbursement methodology.
Electronic Visit Verification Capture Updates
Updates on the Sandata mobile app, telephony and fixed visit verification.
Changes to the 1E-5 Obstetrical Services Policy Effective April 1, 2024
Revised policy in addition to services outlined in Maternity Coverage and Reimbursement Bulletin posted Oct. 23, 2023.
1915(b)(3) Services Transition to 1915(i) Services by June 30, 2024
Providers should work with their Medicaid beneficiary’s health plan and Tailored Care Manager to transition the members to 1915(i) services.