North Carolina Medicaid: Reimbursement rate changes for personal care services
Beginning April 1, 2025, the reimbursement rate for personal care services (PCS) provided to individuals living in congregate (also known as a group living arrangement) settings is changing. Instead of a monthly calculation, PCS health care providers will be paid using per diem pricing. This change is based on the new rate methodology from the North Carolina Department of Health and Human Services.
What this means for you
As a PCS health care provider, you’ll be paid based on the number of approved days (units) in the prior authorization. You can continue to bill your usual customary charge on a weekly or monthly basis. When submitting claims with dates of service on or after April 1, 2025, you must include the following:
- 1 date of service per line
- 1 unit representing the calendar day
To bill for a range of dates, use 1 claim with multiple lines for each date of service. Our system will deny claims that span multiple dates or include a unit greater than 1. Find more information about claims, billing and payments.
Questions? We're here to help.
Check our frequently asked questions to understand how this change will affect your claims submissions. You can also connect with us through chat 24/7 in the UnitedHealthcare Provider Portal. For additional contact information, visit our Contact us page.
PCA-1-25-00448-POE-NN_03132025
