Concurrent Child and Adolescent Day Treatment and Residential Treatment Services remain subject to medical necessity and non-duplication requirements.
Medicaid Bulletin
Articles published prior to January 2018 are available in the Medicaid Bulletin Archive.
A new prior authorization is required for NC Medicaid Managed Care beneficiaries returning to NC Medicaid Direct.
This bulletin clarifies NC Medicaid billing requirements to ensure proper submission of laboratory services.
Effective July 1, 2026, local education agency claims submitted to NCTracks must include the individual ordering, prescribing or referring and rendering provider’s National Provider Identifier.
With the launch of the Children and Family Specialties Plan (CFSP), NC Medicaid enacted policy levers to promote continuity of care for CFSP members and ease the administrative burden on providers.
On April 20, 2027, the Innovations Waiver “Community/Behavioral Health” Service under taxonomy 251S00000X will be end-dated on provider records.
Effective May 2, 2026, use of the pharmacy National Provider Identifier in the prescriber field on Point-of-Sale claims for all protocol drugs will no longer be allowed.
Local Health Departments will continue to offer Care Management for At Risk Children and Care Management for High-Risk Pregnancy services to Medicaid beneficiaries, with Per Member Per Month payments remaining in effect, both through Dec. 31, 2026.
Prime Therapeutics is the New Pharmacy Benefit Administrator for NC Medicaid Direct Point of Sale Pharmacy, effective May 2, 2026.
These revisions are a result of the Current Dental Terminology CDT-2026 American Dental Association (ADA) code updates.