North Carolina Medicaid Revises Reimbursement Model for Personal Care Services
From April 1st, 2025, North Carolina Medicaid implements a major revision to Personal Care Services (PCS) fees, which pay for care delivered to residents of congregate living arrangements. NCDHHS declared the Department of Health and Human Services of North Carolina will change monthly calculations to per-day pricing for payments.
With these changes, providers who deliver PCS healthcare will now get payments starting from April 1, 2025, according to the preapproved days noted in prior authorization documents. The standard customary charge of providers remains available through billing methods based on weeks or months. The acceptance of claims depends on strict submission guidelines for non-rejection.
Key billing requirements include:
- A single date of service should appear in every line of the claim.
- A single unit needs to appear in every line that corresponds to its matching calendar day.
- Multiple-date service providers need to file one claim that includes specific lines for each day of service delivery.
- Claims that contain date ranges along with units greater than one on each line will be denied. Get more information about claims, billing, and payments here.
The objective behind this change is to achieve payment standardization while producing accurate PCS payments within congregate care facilities. Medicaid Services seeks financial transparency through new rate methods that match their overall initiative to streamline healthcare service billing.
All healthcare providers must understand these adjustments because they lead to better billing practices together with payment processing. All UnitedHealthcare stakeholders can access detailed billing information and payment procedures through the UnitedHealthcare Provider Portal.
Anticipating these future adjustments means being ready for them to prevent payment interruptions when processing PCS claims.
