The North Carolina Immunization Program (NCIP) has announced a temporary pause on all North Carolina Immunization Registry (NCIR) data exchange onboarding activities as it transitions to a new NCIR product. Practices, health systems, and vendors planning new NCIR data exchange connections should be aware of this change and prepare for potential delays in onboarding timelines.

North Carolina is taking another step toward improving access to health care in rural communities through the Rural Health Transformation Program (RHTP). In June, the North Carolina Department of Health and Human Services (NCDHHS) and the North Carolina Department of Information Technology (NCDIT) announced three new programs designed to strengthen the digital infrastructure supporting rural health care delivery. These efforts are part of Initiative Six of the North Carolina Rural Health Transformation Program (NCRHTP), which focuses on digital health and technology. 

Providers participating in the North Carolina Medicaid program are reminded of their responsibility to complete regular credit balance audits and submit required Credit Balance Reports. These reports help ensure that any overpayments or improper payments owed back to Medicaid are identified and resolved promptly.

Billing in today’s healthcare environment is rarely straightforward. For many practices participating in NC Medicaid, even well-designed workflows can be disrupted by claim issues, coding updates, and evolving requirements. These challenges not only affect revenue—they also create administrative burden and frustration for care teams already operating at capacity.

We’re excited to launch Session 2 for the Integrated Care Quality Series, a four-part educational series designed to support providers, care teams, and partners in improving outcomes across maternal, preventive, and pediatric care. Aligned with NC Medicaid’s 2026 Withhold Program, this series will provide practical strategies, updated guidance, and actionable tools to strengthen high-quality, equitable care across the care continuum.

All programs in the series are being held via Live Webinar.

These programs are for NC Health Department employees only.

Course registration is generously supported by the North Carolina Alliance of Public Health Agencies.

Session 2 Registration is Now Open
Screening for Health‑Related Resource Needs (HRRN)
August 26, 2026 11AM - 12PM - LIVE WEBINAR

Beginning in 2026, HRRN transitions from pay for reporting to pay for performance, reinforcing NC Medicaid’s commitment to addressing social drivers of health. This session examines required screening components, best practices for documentation, and effective approaches for follow up and linkage to community based resources. Q&A Session will be held two weeks after the event, link will be sent to participants.

Speaker:
Madison Shaffer, MPH
Quality Measurement Lead - Program Evaluation, QPHE, NC Medicaid
NC Department of Health and Human Services

👉 Learn more and register

What’s Coming Next

Future sessions in the series will address:

• Women’s Preventive Health (Cervical & Breast Cancer Screening)
• Child & Adolescent Well-Care and Immunizations

We’ll be announcing additional session details soon, with registration opening shortly for fall offerings.

Did you miss Session 1 Prenatal and Postpartum Care? You can register and watch recording! Check out the website.

Hospital readmissions remain a persistent challenge for health systems and primary care practices alike. While the policy drivers behind readmission reduction are well known, translating those expectations into day-to-day clinical workflows is where the real work begins. For many practices, implementation is less about a single intervention and more about building a coordinated, sustainable approach across the care continuum.

We previously shared important updates regarding the Wellcare and Carolina Complete Health (CCH) merger, including an initial effective date of April 1, 2026. That timeline has now changed.

New Effective Date and Key Change

Effective June 4, 2026, Carolina Complete Health, Trillium Physical Health, and Partners Physical Health have transitioned from claims denials to upfront rejections for certain billing and credentialing issues.

This change means claims with errors will now be rejected before processing rather than denied after submission. Providers will need to correct and resubmit any rejected claims.

What Providers Should Do

To reduce the risk of claim rejections, providers should review their billing and credentialing practices carefully. It is essential to confirm that all information in NCTracks is accurate and up to date, including NPI, taxonomy, service location, and enrollment details. Mismatched or outdated information may result in rejected or denied claims.

Providers should also ensure that NPI and taxonomy codes are placed in the correct fields on all claims and align with the Carolina Complete Health Provider Billing Manual (pages 48 through 74). When services are rendered at a location different from the billing address listed in field 33, boxes 32, 32a, and 32b must be completed as outlined on page 58 of the manual.

Common Reasons for Rejections

Most upfront rejections are related to NPI status, taxonomy alignment, or missing provider information. Common issues include inactive or unrecognized NPIs, missing or invalid taxonomy codes, and discrepancies between credentialing records and submitted claims.

Errors may involve multiple provider roles, including attending, billing, rendering, referring, supervising, and service facility providers. Rejections can also occur when required provider information is missing, not active for the date of service, or not properly linked within NCTracks.

In some cases, claims may be rejected when a rendering provider is required but not submitted for certain billing taxonomies, or when supervising or service facility provider information is incomplete or not found on file.

Why This Matters

Because claims are now rejected before processing, providers may experience delays in reimbursement if errors are not addressed promptly. This shift increases the importance of accurate credentialing data and correct claim submission.

Taking time now to verify NCTracks information and billing practices can help minimize disruptions and reduce administrative burden.

Key Takeaways

• New effective date: June 4, 2026
• Claims are now rejected upfront instead of denied later
• Most issues involve NPI or taxonomy mismatches
• Providers should review and update NCTracks and billing practices

For background information, review our earlier post: Important Updates on the Wellcare and Carolina Complete Health Merger .

Did you know…this time of year, NC AHEC is welcoming new resident physicians, fellows, and health science students to teaching hospitals and community sites across the state. As they begin this next phase of training, easy access to trusted, evidence-based information is essential for both learning and patient care.

• Research Databases: Access to major clinical and biomedical databases, including MEDLINE, CINAHL, and The Cochrane Collection of Evidence-Based Medicine Reviews.
• Journals & E-Books: Thousands of full-text medical/nursing journals and core textbooks.
• Point-of-Care Tools: Includes synthesized clinical tools like Essential Evidence Plus for quick, evidence-based decision-making at the bedside.
• Subject Guides (LibGuides): Specialized resource hubs covering key health topics.
• Certification & Specialty Readings: Curated articles and reading lists—such as the American Board of Obstetrics and Gynecology (ABOG) recommended articles.

Accessible Exam Tables and Scales: What the New Federal Rules

New federal accessibility rules are changing how healthcare facilities must think about exam tables, weight scales, and other diagnostic equipment. These updates are not about convenience or optional upgrades. They are about ensuring that patients who use wheelchairs or have mobility limitations can be weighed, examined, and transferred safely and with dignity—without being examined in their chair or turned away because appropriate equipment is not available.

Two federal actions work together to create these new expectations: updated technical standards from the U.S. Access Board and enforceable legal requirements from the Department of Justice (DOJ). Understanding how they fit together is key for planning, budgeting, and compliance.

The Two Federal Actions Driving These Changes

The U.S. Access Board sets the technical standards. In July 2024, the Access Board finalized updated standards for accessible medical diagnostic equipment (MDE), including exam tables, exam chairs, weight scales, and imaging equipment. These standards define what counts as accessible, such as transfer heights, support features, and clearance requirements. For example, exam tables must be able to lower to a transfer height of 17 inches or less, measured from the floor to the top of the uncompressed surface. Access Board MDE standards

On their own, these standards are not enforced. That role falls to the Department of Justice.

The Department of Justice makes the standards enforceable. In August 2024, the DOJ finalized a new rule under Title II of the Americans with Disabilities Act (ADA) that adopts the Access Board’s standards and applies them to state and local government healthcare facilities, including public hospitals, health departments, public clinics, and university health systems. The rule became effective October 8, 2024, with enforcement beginning August 9, 2026. DOJ MDE fact sheet

What “Exam Tables That Lower Below 17 Inches” Really Means

For patients who use wheelchairs, accessible exam tables are essential for safe transfers and complete physical exams. In practical terms, this means that at least some exam tables in a facility must lower to 17 inches or lower, allow side or end transfers, include support rails or armrests, and provide enough clearance for a wheelchair and staff assistance.

Accessible tables make it possible for patients to transfer independently or with assistance, use transfer boards or mechanical lifts, and avoid unsafe manual lifting by staff. This improves safety for both patients and clinical teams.

An important nuance for planning: the DOJ is currently enforcing the 2017 Access Board standard, which allows a transfer height of 17 to 19 inches. However, the Access Board’s 2024 update sets 17 inches as the maximum low height, and this is now the official technical benchmark. Many organizations are choosing to purchase equipment that meets the 17‑inch standard now to future‑proof their investments. DOJ adoption of Access Board standards

Wheelchair‑Accessible Scales and Combination Equipment

Facilities must also have wheelchair‑accessible weight scales. These scales must include a platform large enough for a wheelchair, a ramp or level entry, edge protection, a slip‑resistant surface, and adequate weight capacity, often including bariatric capacity. Wheelchair scales are explicitly included as medical diagnostic equipment under the rule. HHS accessible MDE requirements

Some facilities ask whether they can combine an exam table and scale. The answer is yes. Combination equipment is allowed as long as it meets both the exam table accessibility standards and the wheelchair scale standards. For some sites, this can reduce space constraints and equipment costs while still meeting compliance expectations. Wheelchair scale accessibility guidance

The 10% Rule: Minimum Equipment Requirements

By August 9, 2026, facilities covered by ADA Title II must ensure that at least 10% of each type of diagnostic equipment is accessible. This applies separately to exam tables, weight scales, exam chairs, and other covered equipment. If 10% would be less than one unit, at least one accessible unit is still required.

Facilities that specialize in mobility‑related care, such as rehabilitation or physical therapy, have a higher threshold: 20% of each equipment type must be accessible. ADA Title II equipment scoping requirements

Who These Rules Apply To

These requirements apply to state and local government healthcare facilities under ADA Title II, as well as federally funded providers under Section 504 of the Rehabilitation Act. This includes many providers that participate in Medicare and Medicaid.

Similar timelines apply under federal funding rules, with a deadline of July 8, 2026 to have at least one accessible exam table and one accessible weight scale in place. Section 504 MDE deadlines

Importantly, the rules do not require replacing all existing equipment, removing non‑compliant equipment immediately, or making changes that would create an undue financial or administrative burden. However, claims of undue burden must be documented.

What Most Facilities Need to Do Now

For many organizations, compliance is less about a full renovation and more about targeted planning. Common steps include purchasing or retrofitting at least one exam table that lowers to 17–19 inches (preferably 17 inches), ensuring at least one wheelchair‑accessible scale is available, confirming bariatric capacity where appropriate, and verifying that new equipment purchases after October 8, 2024 meet accessibility standards.

Facilities should also review space and workflow. This includes ensuring clear floor space next to accessible equipment, providing an accessible route to the room where compliant equipment is located, and having a scheduling process that ensures wheelchair users can access those rooms when needed.

Staff training and policy updates are equally important. Staff should be trained on safe transfers, use of accessible equipment, and lift and support features. Policies should clearly prohibit denying exams or services due to lack of accessible equipment.

Why This Matters Beyond Compliance

Facilities that fail to comply may face DOJ enforcement actions, ADA complaints, or lawsuits. But the impact goes well beyond regulatory risk. Accessible equipment reduces staff injuries, improves exam quality, and helps prevent delayed or skipped care for patients with mobility disabilities.

For many organizations, these changes are also an opportunity to improve patient experience, demonstrate commitment to equity, and modernize clinical workflows in a way that benefits both patients and staff.

If helpful, this information can be translated into a site‑specific gap analysis, equipment prioritization plan, or plain‑language talking points for leadership and providers.

Which ADA Rules Apply to Your Practice?

Which accessibility rules your practice must follow depends primarily on who owns and operates the practice. Under the Americans with Disabilities Act (ADA), healthcare providers fall under different titles of the law, and those titles carry different requirements.

If your practice is run by a state or local government (ADA Title II)

Healthcare services operated by state or local governments are covered by ADA Title II. This includes public hospitals, county or city health departments, public clinics, and university or academic health systems that are part of a public institution. It also applies when a government entity owns a facility but contracts with another organization to operate it.

Title II requires program accessibility. In practical terms, this means the healthcare program as a whole must be accessible to patients with disabilities, not just on a case‑by‑case basis. Because of this broader obligation, Title II providers are subject to the Department of Justice’s new, enforceable rules for accessible medical diagnostic equipment, including required numbers of accessible exam tables and wheelchair‑accessible scales and defined compliance deadlines.

If your practice is privately owned (ADA Title III)

Private and nonprofit healthcare practices that serve the public are covered by ADA Title III. This includes private physician offices, private hospitals, dental practices, urgent care centers, and specialty clinics.

Title III focuses on non‑discrimination and removal of barriers when it is readily achievable. Unlike Title II, it does not set fixed percentages or quotas for accessible medical equipment. However, Title III practices still may not deny care because equipment is inaccessible and must make reasonable modifications to ensure patients with disabilities can receive the same services as others.

Why many private practices are still affected by the new equipment standards

Even if a practice is covered by Title III, it may also be subject to Section 504 of the Rehabilitation Act if it receives federal financial assistance. This includes participation in Medicare or Medicaid.

Section 504 adopts the same technical standards for accessible medical diagnostic equipment and includes its own deadlines for having accessible exam tables and scales in place. As a result, many private practices are functionally required to meet the same equipment standards as public facilities, even though they are not Title II entities.

In short, public providers must follow the DOJ’s specific equipment rules under Title II, while private providers must meet Title III’s access requirements and may also need to comply with Section 504 if they receive federal funding. Understanding which category your practice falls into is the first step in planning for compliance.

NC Medicaid’s May 2026 Back Porch Chat highlighted several updates that affect providers across the state, including new data tools, pharmacy benefit changes, and updates to care management programs. These sessions are designed to keep providers informed about program changes and resources that support care delivery.

Below is a summary of key updates and what they mean for your practice.

New TBI Dashboard Improves Access to Data

NC Medicaid introduced a new Traumatic Brain Injury (TBI) dashboard that provides a centralized, publicly accessible view of service use across the state.

The dashboard was developed in response to the need for more transparent and actionable data. It allows users to better understand who is accessing TBI services, what types of services are most commonly used, and how frequently those services are delivered.

This tool is intended to support a wide range of stakeholders, including providers, policymakers, advocates, and individuals with TBI and their caregivers. By making this information more accessible, the dashboard can help inform program planning and guide decisions about resource allocation across North Carolina.

New Pharmacy Benefit Administrator Transition Now in Place

NC Medicaid also shared updates about the transition to a new Pharmacy Benefit Administrator (PBA). Prime Therapeutics began serving in this role on May 2, 2026, and now processes all Medicaid Direct pharmacy point-of-sale claims.

For providers, the transition is intended to simplify pharmacy-related processes while improving transparency and consistency in how pharmacy benefits are managed. Importantly, the state retains authority over clinical policies and reimbursement methodologies, which means core program rules remain unchanged.

Providers working with Medicaid Direct should be aware that pharmacy prior authorizations are now handled through Prime Therapeutics. However, there are no changes to pharmacy processes within Medicaid Managed Care plans, and providers should continue to follow their existing workflows for those patients.

Care Management Programs Extended Through 2026

NC Medicaid announced an extension for two longstanding care management programs: Care Management for At-Risk Children (CMARC) and Care Management for High-Risk Pregnancies (CMHRP). These programs support vulnerable populations including young children and pregnant individuals at higher risk for complications.

Local Health Departments will continue to provide these services through December 31, 2026, extending the current arrangement by six months beyond the previously planned transition date. Existing payment structures and technology support will remain in place during this period.

Additional guidance is expected regarding how care management for these populations will be structured beginning in 2027, so providers should watch for future updates.

New Quality Measures Dashboard Supports Performance Improvement

NC Medicaid is also advancing efforts to make quality data more accessible through a new public-facing Quality Measures Dashboard. This tool is designed to help providers and stakeholders better understand performance across the Medicaid program.

The dashboard allows users to view and compare quality measures across managed care plans and explore results by demographic and geographic factors. By making this information easier to access and interpret, NC Medicaid aims to support continuous quality improvement and help identify opportunities to improve patient outcomes.

The measures included focus on key areas such as preventive care, chronic disease management, and follow-up after hospitalization, reflecting priorities that align closely with primary care and population health efforts.

Why These Updates Matter for Providers

Taken together, these updates reflect a continued focus on transparency, data-driven decision-making, and coordinated care. New dashboards provide greater visibility into both service use and quality outcomes, while program updates aim to reduce disruption and maintain continuity of care for vulnerable populations.

For providers, these changes offer new tools to support clinical decision-making and population health management, while also reinforcing the importance of staying current with evolving Medicaid processes and requirements.

Learn More

To explore these updates in more detail and access related training materials, visit the NC Medicaid Provider Playbook:

Provider Playbook Training Courses – Second Quarter 2026 Meeting (May 21, 2026)