Medicaid Bulletin

Articles published prior to January 2018 are available in the Medicaid Bulletin Archive.

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NC Managed Care Capitation Rates – Updated Care Management Assumptions for SFY 2025

This bulletin applies to NC Medicaid Managed Care Standard Plans.

Advanced Medical Home Provider Manual May 2024 Released
AMH Provider Manual May 2024 reflects all program modifications and changes that impact provider contracts and operations.
Adding Coverage of Diagnosis Codes Z31.430 and Z31.440
Effective retroactive to April 1, 2023, Z31.430 and Z31.440 will be covered diagnosis codes in NCTracks.  
Prior Approvals for Private Duty Nursing Will Transition to NCTracks July 28, 2024
Training for Providers begins Friday, June 28. Additional dates are listed in this bulletin.
NC Medicaid Managed Care Provider Update – June 20, 2024
Provider Data Management / Credentialing Verification Organization (PDM/CVO) Solution New Launch Date of 2026. Includes information on the New Launch Date for PDM/CVO, Healthy Opportunities Pilot, Provider Fact Sheets, Reverification Updates and more.
Adding Physical Therapists to Electrodiagnostic Studies Correction
Medicaid corrected the reimbursement issue and reprocessed claims for nerve conduction tests performed by physical therapists.
Adding Coverage for Point of Care Rapid testing for Syphilis and HIV

This bulletin applies to NC Medicaid Managed Care and NC Medicaid Direct.

Terminating Coverage of CPT Code 80050 – General Health Panel
Effective retroactive to Jan. 1, 2022, CPT code 80050 will no longer be reimbursed.
Provider Data Management / Credentialing Verification Organization Solution New Launch Date of 2026
The PDM/CVO solution will consolidate provider data management and coordinate provider enrollment, credentialing, and ongoing data maintenance.
Reminder on Hospital Observation Policy
Providers should review Clinical Coverage Policy 2A-1 for information on Hospital Observation