Medicaid Bulletin

Medicaid Bulletin Monthly Digest

Medicaid Bulletin Archive

Articles beginning January 2018 are available in the blog format.

Healthy Opportunities Pilot launches for Medicaid Direct Populations
Expanding Pilot Eligibility to Members in NC Medicaid Direct in Pilot Regions
Medicare Enrollment Required for Certain Providers Serving Dually Eligible Beneficiaries
Billing Requirements for Medicaid Direct Providers
Reverification Timeliness and Requirements Clarification
States must revalidate the enrollment of all providers at least every five years to ensure the information on record is accurate and current.
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.