Medicaid Bulletin

The Centers for Medicare & Medicaid Services has released 80 new ICD-10-PCS codes, Effective April 1, 2026.

Following stakeholder engagement and review of departmental priorities, NC Medicaid will not be implementing the Advanced Medical Home (AMH) Standardized Performance Incentive Program (SPIP) at this time.

This bulletin updates the previously published NC Medicaid Direct Pharmacy Benefits Administrator Provider Transition Overview and Webinars bulletin.

NC Medicaid providers must accurately answer all Exclusion Sanction questions.

Evaluates the influence of NC Medicaid Transformation on primary care and obstetrics/gynecology practices that contract with NC Medicaid.

The North Carolina Department of Health and Human Services (NCDHHS) reminds pharmacy providers that Prime Therapeutics State Government Solutions LLC (Prime Therapeutics) will serve as the Pharmacy Benefits Administrator (PBA) for NC Medicaid Direct point-of-sale (POS) pharmacy benefits beginning May 2, 2026.

The Department is no longer requiring compliance with Tobacco-free Campus Policy Requirements by Jan. 1, 2027.

Applications must be submitted no later than March 22, 2026, at 11:59 p.m.

An out-of-date NCTracks provider record jeopardizes continued NCDHHS program participation.

For NC Medicaid and Division of Mental Health, Developmental Disabilities, and Substance Use Services (DMHDDSUS) State Funded Behavioral Health Providers.