Medicaid Bulletin

The 2023 ICD-10 update is effective Oct. 1, 2022, through Sept. 30, 2023, for provider use for dates of service within this period.

Providers should contact the PHPs and Provider Ombudsman to resolve issues.

Key milestones, playbook updates, verifying eligibility, provider reverification, provider records, behavioral health services transition and more

Updates to Clinical Coverage Policy 1A-5 with an effective date of Sept. 2, 2022.

Attention Standard Plans/Tailored Plans/HHA Exchange/CareBridge and Healthy Blue

Updates on Tailored Plan criteria review, eligibility criteria, enrollment and health care options, and resources for Beneficiaries and Providers.

What services are available, in which regions, and how providers can refer patients.

Providers shall not bill a NC Medicaid beneficiary for services furnished to a beneficiary who the provider has accepted as a Medicaid patient.

The adjudication of some prior approvals will be performed by GDIT Fiscal Agent Operations Reviewers instead of clinical reviewers at NC Medicaid

NC Medicaid is working with Standard Plans to create easier pathways for providers to reach Standard Plans and resolve panel issues.