Medicaid Bulletin

Medicaid Bulletin Monthly Digest

Medicaid Bulletin Archive

Articles beginning January 2018 are available in the blog format.

Durable Medical Equipment and Orthotic and Prosthetic Manually Priced Procedure Codes - Prior Authorization Update
A new prior authorization is required for beneficiaries returning to NC Medicaid Direct
piflufolastat F18 Injection, for Intravenous Use (Pylarify®) HCPCS Code A9595 - Piflufolastat f-18, diagnostic, 1 millicurie: Billing Guidelines
Effective with date of service, Dec. 21, 2022, the NC Medicaid and NC Health Choice programs cover piflufolastat F18 injection
2023 NC Medicaid Quality Symposium - Partnering for Performance
Register now for the diabetes self-management presentation on May 11 and adolescent immunization on May 16.
Local Management Entity/Managed Care Organization Enrollment Changes for April 1, 2023
Behavioral health prior authorizations effective April 1, 2023
NC Medicaid Managed Care Provider Update – March 22, 2023
Implementation of Tailored Plans, playbook update, Provider reverification, NC Health Choice move to Medicaid, NCTracks Provider records and more.
Lantus Update on NC Medicaid Preferred Drug List for NC Medicaid Direct
Lantus® SoloStar® / Vial will move to preferred on the NC Medicaid Preferred Drug List, effective March 24, 2023.
SPECIAL BULLETIN COVID-19 #266: Update on Temporary COVID-19 Rate Increases
Rate increases continuing and effects on managed care plans and contracted providers
Provider Reverification Process Update - March 15, 2023
Providers for whom reverification was delayed are being organized into groups to ensure reverification is completed timely. 
North Carolina Standard Plan, Tailored Plan and LME/MCO Tobacco-Free Policy Requirement
Tobacco-related policy requirements go into effect on April 1, 2024.
NC Medicaid Managed Care Capitation Rates – Care Management Assumptions
Updated information about the assumptions underlying the care management component of capitation payments to Standard Plans