Medicaid Bulletin

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

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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
Flexibilities to Ease Provider Administrative Burden at Tailored Plan Launch
Includes medical and pharmacy prior authorizations, out of network provider rates and rules, and primary care provider changes
Nicotine Replacement Therapy Protocol Reimbursement Effective Aug. 1, 2024
Usage of the Nicotine Replacement Therapy Protocol is Eligible for Clinical Services Reimbursement to Pharmacies.
Tailored Care Management Options for Transitions to Community Living Medicaid Members
Members may now select to receive Tailored Care Management from a provider with Transition to Community Living Distinction.
Value-Based Payment Update: Making Care Primary (MCP) Model Alignment in NC Medicaid
Feedback Requested on Proposed Approach
Nursing Home Assessment Provider Portal Upgrade
To support the SNF and ICF-IID reporting and collection of provider healthcare assessment data.
Healthy Opportunities Pilot launches for Medicaid Direct Populations
Expanding Pilot Eligibility to Members in NC Medicaid Direct in Pilot Regions