Medicaid Bulletin

What services are available, in which regions, and how providers can refer patients.

Providers shall not bill a NC Medicaid beneficiary for services furnished to a beneficiary who the provider has accepted as a Medicaid patient.

The adjudication of some prior approvals will be performed by GDIT Fiscal Agent Operations Reviewers instead of clinical reviewers at NC Medicaid

NC Medicaid is working with Standard Plans to create easier pathways for providers to reach Standard Plans and resolve panel issues.

Effective July 1, 2022, Medicaid and NC Health Choice cover kit for the preparation of Gallium Ga 68 gozetotide injection

Provider manual update, guidance on position qualifications, phased assignment approach for Tailored Care Management providers and more.

Service field location effective date change from Oct. 5, 2022, to Jan. 1, 2023

NCDHHS will implement an Electronic Visit Verification system for Home Health Care services starting with a soft launch Jan. 1, 2023, and a hard launch April 1, 2023. This complies with the 21st Century Cures Act.

NC Medicaid is sharing a list of member counts for Advanced Medical Home practices affiliated with Tailored Plans

Effective June 22, 2022, Medicaid and NC Health Choice cover Nalmefene hydrochloride injection (Revex™)