Medicaid Bulletin

Medicaid Bulletin Monthly Digest

Medicaid Bulletin Archive

Articles beginning January 2018 are available in the blog format.

Reprocessing of Outpatient Claims with Revenue Code 025x and 063x and Missing Required Data

Starting in November 2023, Standard Plans and Medicaid Direct will reprocess claims without appropriate documentation of required codes.

NC Medicaid to Extend Appendix K Temporary Flexibilities until Feb. 29, 2024

Flexibilities extended while the Centers for Medicare & Medicaid Services reviews the Innovations and Traumatic Brain Injury Waiver amendments.

NCDHHS Awards Contract for Pharmacy Benefits Management Solution

Magellan Medicaid Administration, LLC has been awarded a contract to implement the solution, scheduled to launch in 2025.

Medicaid Expansion Family Planning Mailing

Starting today, more than 260,000 people will receive a notification that they will get full Medicaid Benefits beginning Dec. 1, 2023.

Update: TBI Waiver 1915 (c) and Appendix K Flexibilities

Amended waiver submitted to the Centers for Medicare and Medicaid Services

Update: Innovations 1915(c) and Appendix K Flexibilities

Amended waiver submitted to the Centers for Medicare and Medicaid Services.

NC Medicaid Respiratory Syncytial Virus (RSV) Guidelines for 2023-2024 - Revised

This bulletin is replaced by Additional NC Medicaid Respiratory Syncytial Virus (RSV) Guidelines for 2023-2024 published on Jan. 24, 2024.

Innovations Waiver Amendment Update

Appendix K flexibilities to continue if waiver amendment is not approved by Nov. 11, 2023

Minimum Data Set (MDS) Section Q Referrals Process Change

Beginning Nov. 6, 2023, Section Q Referrals should be made to Acentra

Maternity Coverage and Service Reimbursement Updates

NC Medicaid is implementing changes due to Session Law 2023-14 and to implement additional clinical best practices for maternity care.