MedicaidAdministrativeMedium impact
Ordering, Prescribing or Referring and Rendering Provider Requirements for Local Education Agency Claims
NC Medicaid - NCDHHS·NC · Physical Therapy, Occupational Therapy·Provider Bulletin
Effective date
Jul 1, 2026
We identified it
Jun 16, 2026
Summary
Effective July 1, 2026, Local Education Agency (LEA) claims for NC Medicaid Direct must include individual National Provider Identifiers (NPIs) for ordering/prescribing/referring providers and rendering providers. All providers must be actively enrolled in NC Medicaid, and Physical/Occupational Therapy services must be ordered/prescribed while Speech-Language Pathology and Audiology services must be referred.
Action Required
Before July 1, 2026: LEA billing teams must update NCTracks claim submission processes to include individual ordering/prescribing/referring NPIs in both ordering and referring provider fields, and rendering provider NPIs in rendering provider fields. Ensure all providers are enrolled in NC Medicaid using the 'Enrolled Practitioner Search' function on NCTracks Provider Portal. Update billing workflows to distinguish between Physical/Occupational Therapy (requires ordering/prescribing) and Speech-Language Pathology/Audiology (requires referral). Claims without proper NPI information will be rejected.