Alliance_health_nc Coverage Criteria
Latest Alliance_health_nc coverage criteria updates6
- Coverage CriteriaClinical/Medical PolicyEff. 2026-01-01Genetic testing — gene expression (coverage criteria)Medicaid clinical coverage policy describing gene expression testing (definitions, coverage framework, and requirements) for beneficiaries enrolled in NC Medicaid PHPs. This part of the document provides background, definitions, and table-of-contents level structure affecting providers, labs, and prior authorization processes.All alliance_health_nc updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-05-01NC Medicaid Nursing Durable Medical Equipment and SuppliesState Medicaid clinical coverage policy describing eligibility, coverage criteria, prior approval, documentation, delivery, monitoring, servicing, replacement, and provider rules for durable medical equipment (DME) and supplies for Alliance Health NC members.All alliance_health_nc updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-01-01NC Medicaid Ambulatory Withdrawal Management Without Extended On‑Site MonitoringDefines NC Medicaid coverage, eligibility, and specific clinical criteria for outpatient (ASAM Level 1) ambulatory withdrawal management services without extended on‑site monitoring for beneficiaries enrolled in NC Medicaid.All alliance_health_nc updates
- Coverage CriteriaClinical/Medical PolicyClinically Managed Population Specific High-Intensity Residential Program (ASAM Level 3.3) for beneficiaries with SUD and TBIDefines Medicaid coverage, eligibility, and specific clinical criteria for a high-intensity residential rehabilitation program (ASAM Level 3.3) for beneficiaries with co-occurring substance use disorder (SUD) and traumatic brain injury (TBI) in the NC Medicaid program.All alliance_health_nc updates
- Coverage CriteriaClinical/Medical PolicyGenetic and molecular testing — coverage criteriaDefines genetic testing types, key terminology, and coverage provisions relevant to beneficiaries of the Prepaid Health Plan (PHP); applies to use, definitions, and administrative provisions for genetic testing services.All alliance_health_nc updates
- Coverage CriteriaClinical/Medical PolicyNC Medicaid Substance Abuse Comprehensive Outpatient Treatment (SACOT)Defines coverage, eligibility, and program requirements for SACOT (ASAM Level 2.5) for NC Medicaid beneficiaries aged 18 and older, including service components, EPSDT exception language, and general medical necessity criteria.All alliance_health_nc updates
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