Enhancements to PDN Prior Approval and Claims Processing Effective July 13, 2025

This bulletin applies to NC Medicaid Direct.

These updates will support providers delivering in-home services during school hours due to school closures or illness.

Key Changes Effective July 13, 2025

Provider Portal Updates:

• The PA entry detail page will now support requests for missed school care. Providers should select “MISSED SCH” as the place of service to indicate school-hour coverage or anticipated school-hour coverage.
  • The existing “SCHOOL” option will be removed.
  • The entry field label has been updated from “Hours Per Week” to “Requested PDN Hours”.
  • A new on-screen message provides guidance for accurately entering missed school hours and selecting the correct place of service.

Reminder: Missed school visits include sick days, adverse weather days and scheduled school closings. Providers may request up to 60 hours per calendar year as a separate detail line on an initial, continuation, reauthorization or shared care request.

Requests for hours beyond the 60-hour allowance must be submitted separately under the Increase of Hours service type.

Prior Authorization (PA) Letters:

PA letters will now reflect “Total Hours” for missed school services versus “Hours per Week”.

Contact

If you have questions, please contact the NCTracks Call Center at 1-800-688-6696.