Medicaid Bulletin

This Special Bulletin is being released to inform NC Medicaid providers of COVID-19 rate reimbursement that providers will receive from Prepaid Health Plans (PHPs) under NC Medicaid Managed Care.

ADDENDUM to Special Bulletin #168: The addendum was updated to include information regarding guidance on billing and coding criteria, guidance for parents, counseling methods, reimbursement ranges and the time frame during which the code is valid.

This Bulletin includes key milestone dates for NC Medicaid Managed Care, Provider Playbook updates, prior authorization updates, contracting reminders, information about health plan events, the provider ombudsman and upcoming AHEC events and webinars. It also includes information about the Provider and Health Plan Lookup Tool, PHP Quick Reference Guide and the NC Medicaid Help Center.

This is a reminder to include taxonomy codes when submitting claims to PHPs, either by individual providers or through a trading partner.

A new clinical coverage policy, 1S-5 Genetic Testing for Susceptibility to Breast and Ovarian Cancer, became effective July 1.

Carolina Access Providers who received health equity payments are asked to complete this survey by July 16.

Additional information on prior authorization is available.

On July 1, 2021, an amended version of the policy was posted.

Four Months Left to Submit Program Year 2021 Attestations and the Security Risk Analysis.

The goal for Day One is that people get the care they need and providers get paid.