Medicaid Bulletin

Articles published prior to January 2018 are available in the Medicaid Bulletin Archive.

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Escalation Process for Standard Plan Provider Claims Payment Issues
Providers are encouraged to contact health plans to address any discrepancies in claim payment issues prior to escalating to the Provider Ombudsman
ICD-10 Annual Update Reminder
The 2025 ICD-10 update is effective Oct. 1, 2024, through Sept. 30, 2025, for provider use for dates of service within this period.
NC Medicaid Respiratory Syncytial Virus (RSV) Guidelines for 2024-2025
Guidance based on products approved by the FDA and recommended by the CDC Advisory Committee on Immunization Practices (ACIP).
NC Medicaid Behavioral Health I/DD Tailored Plans Federally Qualified Health Center /Rural Health Clinics PPS-APM wrap payment methodology
Reimbursement methodology changes revised to begin with dates of service on or after Dec. 1, 2024.
Upcoming Changes to Service Location Management; Draft Applications to be Deleted
Effective Aug. 25, 2024, providers cannot modify an existing service location address in NCTracks without creating a new service location address
NC Medicaid to Cover Imported Benzathine Benzylpenicillin Tetrahydrate (Lentocilin): Billing Guidelines
Coverage effective for dates of service from July 26, 2024
NC Medicaid Increasing Reimbursement Rates for the Substance Abuse Intensive Outpatient Program and Substance Abuse Comprehensive Outpatient Treatment
Rate Changes are Effective Aug. 1, 2024
NCTracks Multi-Factor Authentication (MFA) Updates Coming Soon for Individual & Business Users
Users must update their NCID profile by Sept. 6, 2024.
Community Alternatives Program for Disabled Adults 1915(c) Home and Community-Based Services Waiver Renewal

The NC Medicaid Community Alternatives Program for Disabled Adults (CAP/DA) §1915(c) Home and Community-Based Services (HCBS) expires Oct. 31, 2024. NC Medicaid is seeking to renew the waiver for another five years.

Clarification for Clinical Coverage Policies 5A-2, Respiratory Equipment and Supplies and 1A-20, Sleep Studies and Polysomnography Services
Clarification to recent policy and billing questions