Medicaid Bulletin

Medicaid Bulletin Monthly Digest

Medicaid Bulletin Archive

Articles beginning January 2018 are available in the blog format.

SPECIAL BULLETIN COVID-19 #264: Pfizer & Moderna Bivalent COVID-19 Booster Vaccines
Pfizer & Moderna Bivalent COVID-19 booster vaccine billing and claims information
ProAir Manufacturer Discontinuation
Ventolin® HFA will shift from Non-Preferred to Preferred on the Preferred Drug List (PDL), effective Sept. 23, 2022.
Ensure Your Information Displays Correctly in NC’s Provider Directory Tool – Provider & Health Plan Look-Up
Every page of the NCTracks provider record should be assessed for accuracy.
Procedures for Prior Authorization of Palivizumab (Synagis®) for Respiratory Syncytial Virus Season 2022/2023
Coverage season starts Oct. 1, 2022.
ICD-10 Annual Update Reminder
The 2023 ICD-10 update is effective Oct. 1, 2022, through Sept. 30, 2023, for provider use for dates of service within this period.
Provider Claims Payment Issues
Providers should contact the PHPs and Provider Ombudsman to resolve issues.
NC Medicaid Managed Care Provider Update – Sept. 16, 2022
Key milestones, playbook updates, verifying eligibility, provider reverification, provider records, behavioral health services transition and more
Updates to Clinical Coverage Policy 1A-5, Child Medical Evaluation and Medical Team Conference for Child Maltreatment Policy
Updates to Clinical Coverage Policy 1A-5 with an effective date of Sept. 2, 2022.
Electronic Visit Verification Home Health Services Taxonomy and Bill Type Information
Attention Standard Plans/Tailored Plans/HHA Exchange/CareBridge and Healthy Blue
Tailored Plan Eligibility and Enrollment Updates for Aug. 1, 2022, Auto-Enrollment
Updates on Tailored Plan criteria review, eligibility criteria, enrollment and health care options, and resources for Beneficiaries and Providers.