Medicaid Bulletin

Including a behavioral health post-enrollment accreditation update, recent provider communications and more.

NC Medicaid has contracted with Health Management Systems to conduct Overpayment Recovery Reviews for Medicaid beneficiaries.

NC Medicaid Launching New Services for Eligible Justice-Involved Youth under CAA 5121 in all Youth Development Centers.

Updating the date format requirement for Hospital UR Plan submission.

Important information for Behavioral Health organization providers, including those enrolled in taxonomy 251S00000X.

Providers selected for quarterly NC Medicaid Internal Audits will be notified only using the QiRePort Provider Interface.

Redistributing Previously Approved Shared Private Duty Nursing Hours Among Service Providers without a New CMS-485 or PDN Ordering Provider Order, Effective September 1, 2026

Beginning Nov. 1, 2026, Pharmacy Claims for controlled substances will be denied without an active certification on their NCTracks provider enrollment record.

This bulletin reflects revised effective dates and applies to all research‑based behavioral health treatment providers in NC Medicaid Managed Care and NC Medicaid Direct.

This fall, care managers, caregivers and providers supporting high‑risk Medicaid beneficiaries are invited to join a three‑part webinar series focused on preparing for, responding to and recovering from extreme weather events.