If your organization participates in the Aetna State Plan, we advise you to confirm your participation ahead of the January 1, 2025 launch date!

Effective January 1, 2025, Aetna will replace Blue Cross Blue Shield NC for the NC State Health Plan coverage.

Which plans are included?

• Enhanced PPO Plan (80/20)
• Basic PPO Plan (70/30)
• High Deductible Health Plan (HDHP)

This change does NOT impact members enrolled in the Humana Medicare Advantage plans.

The current pharmacy benefit manager (CVS Caremark®) will not change.

Humana Military's claim processor will switch from Wisconsin Physicians Service (WPS) to PGBA LLC, effective January 1, 2025.

Key Changes:

EDI Claims:

• The 2025 TRICARE East Payer ID is 99727

Claims and Document Submissions:

• Starting January 1, 2025, use XPressClaims via provider self-service

Clearinghouse Requirements:

• New submitters must file a Trading Partner Agreement and Enrollment Form to obtain a          mailbox/submitter ID
• Confirm Payer ID 99727 is enabled if your clearinghouse already files claims to PGBA
• If your clearinghouse does not submit to PGBA, files can be uploaded directly if they meet ANSI     X12 standards.
• Batch claims processing is available through the EDI Gateway mailbox system.
• Complete a PGBA EDI Provider Agreement to submit claims electronically

Claims with 2024 Dates of Service (DOS)

• WPS will process claims with 2024 DOS until April 30, 2025
• After April 30, 2025, submit 2024 claims via XPressClaims or the clearinghouse.
• Ensure all documentation and disputes are submitted promptly before April 30, 2025.

ERA/EFT Enrollment:

• Re-enroll in ERA/EFT by January 1, 2025 even if currently enrolled. (click 'I am staying in East Region'). 
• Note: T17 EFT/ERA applications will no longer be accepted after this date.

Source: Tricare EFT Changes Coming in 2025

A Year of Innovation and Progress
As 2024 comes to a close, we at Northwest Area Health Education Center (AHEC) reflect on an extraordinary year of adaptation and advancement. From addressing workforce challenges to promoting value-based care, the contributions from our partners in the Practice Support Community have driven remarkable progress. Together, we’ve expanded telehealth capabilities, targeted health disparities, integrated mental health services in primary care, and explored the potential of artificial intelligence in patient care. The commitment from the Health Care Professionals in the Practices we Support has been pivotal in improving healthcare delivery across our community.

Key Achievements
This year, our Practice Support team engaged with healthcare practices in 29 counties, completing 2,481 coaching encounters across 27 topics. From guiding Medicaid Expansion to addressing disaster recovery and optimizing electronic health records (EHR), our coaches worked tirelessly to meet your diverse needs. Highlights include support for advanced medical home (AMH) tiers, billing and coding assistance, and quality improvement projects for diabetes management and pediatric immunizations. The team assisted on key behavioral health initiatives including 99 Tailored Care Management coaching encounters and 115 encounters regarding Collaborative Care Model implementation which integrates behavioral health into primary care.

Figure 1: Encounter Topics 2024

Figure 2 Encounters Per County 2024

Expanding Resources and Outreach
Northwest AHEC has broadened its reach through various digital initiatives. Our Practice Support Blog featured 95 posts with over 5,500 views, while our online courses—covering topics such as diabetes care and behavioral health integration—garnered strong participation. Additionally, our 13 curated Library Resource Guides offered accessible, actionable knowledge for healthcare professionals across disciplines.

Looking Ahead to 2025
In 2025, Northwest AHEC will continue focusing on innovative strategies such as leveraging AI for improved clinical decisions, enhancing cybersecurity to protect patient data, and prioritizing sustainable healthcare practices. Our vision remains rooted in equipping practices to navigate the evolving healthcare landscape while maintaining a steadfast commitment to quality and equity in care.

Partnering for a Healthier Future
Your dedication and collaboration fuel our shared success. Our quality improvement services remain available at no cost to eligible practices, ensuring access to tailored support for clinical and operational advancements. Together, let’s continue to enhance healthcare delivery and improve the health of our communities. To connect with a practice support coach, submit an application here or email practicesupport@ncahec.net for more information.

Thank you for being an essential part of the Northwest AHEC community. Let’s make 2025 another year of impactful progress!

Today we bring you News and Updates from NCTracks:

Federal Provider Enrollment Application Fee Increase for Year 2025

A Message from NCTracks on Behalf of NC Medicaid

The federal fee for Medicaid enrollment has increased to $730 for calendar year 2025.

The Centers for Medicare & Medicaid Services (CMS) Federal Register 89 FR 95215 (see Medicare, Medicaid, and Children's Health Insurance Programs; Provider Enrollment Application Fee Amount for Calendar Year 2025) finalized provisions related to the imposition of application fees as part of the Medicaid provider enrollment process for institutional providers and suppliers. The fee will vary from year to year pursuant to the consumer price index for all urban consumers (CPI-U). 

The federal fee for Medicaid enrollment will increase from $709 to $730 for calendar year 2025, and effective Jan 1, 2025, will be required as noted on the Provider Permission Matrix for:

• Initial enrollment;
• Re-enrollment;
• Adding a new owner or a new site location; and
• Re-verification.

Quality Payment Program Small Practices Newsletter: December 2024

The Quality Payment Program (QPP) Small Practices Newsletter is a monthly resource that provides small practices (15 or fewer clinicians) with program updates, upcoming QPP milestones, and resources to support their continued participation and success in QPP. We send this newsletter on the second Tuesday of each month.

LUNCH n' LEARN

NC HealthConnex: New Look for Easier Navigation

South Piedmont AHEC's Maria Goergen will host an informative Lunch n' Learn session on December 17th from noon - 1 p.m.  See the latest updates and improvements to NC HealthConnex (NCHIE) that will make navigation simpler and more efficient for your practice.

We hope you take advantage of this learning opportunity. 

Click below to register (there is no fee for this event).

We look forward to connecting with you!

Register for Lunch n' Learn

MEDICAID MANAGED CARE

Virtual Office Hours

NC Medicaid Initiatives & Updates

Thursday, December 5 | noon-1 p.m.

Effective January 1, 2025, Aetna will replace Blue Cross Blue Shield NC for the NC State Health Plan coverage.

Which plans are included?

• Enhanced PPO Plan (80/20)
• Basic PPO Plan (70/30)
• High Deductible Health Plan (HDHP)

This change does NOT impact members enrolled in the Humana Medicare Advantage plans.

The current pharmacy benefit manager (CVS Caremark®) will not change.

You know the health of your patients.

Do you know the financial health of your practice?

• Where does your practice stand related to financial benchmarks like days in accounts receivable?
• Do you understand your payer mix?
• What is your process for auditing for lost revenue?

North Carolina AHEC has a free tool that you can use to track your practice's financial health.

Medicaid Managed Care Fireside Chat