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Medicare Telehealth Waivers Extended Through 2027: What Practices Need to Know

Feb 18, 2026 3:00:00 PM / by Practice Support Team posted in telehealth

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Designer (1)-2Recent federal action brings welcome stability to telehealth services for Medicare providers and patients. Congress has formally extended key Medicare telehealth waivers through December 31, 2027, ensuring continuity after a brief lapse earlier this year.

For practices that rely on telehealth—particularly in primary care, behavioral health, rural health, and safety‑net settings—this extension reduces near‑term uncertainty and allows for more confident planning.


Stay Informed on Telehealth Policy

Ongoing telehealth policy changes can be complex and fast‑moving. The Center for Connected Health Policy (CCHP) is a trusted national resource that tracks federal and state telehealth developments. Practices can receive timely updates by signing up for CCHP newsletters at
Center for Connected Health Policy 


Medicare Telehealth Waivers Extended Through 2027

As an update to last week’s developments, the Medicare telehealth waivers that expired on January 30, 2026 have now been formally extended. Congress passed H.R. 7148, the Consolidated Appropriations Act, 2026, and the bill was signed into law last week. Importantly, the legislation retroactively covers the brief lapse period, restoring continuity to Medicare telehealth coverage.

This law extends key Medicare telehealth flexibilities through December 31, 2027, preventing a return to permanent, pre‑pandemic Medicare telehealth policy. These waivers have been in place since 2020, when the COVID‑19 public health emergency began, and have been extended multiple times—often for short periods. This nearly two‑year extension provides greater stability for both providers and patients who rely on telehealth services.


Telehealth Waivers That Are Now Extended

Under the new legislation, the following Medicare telehealth waivers remain in effect through the end of 2027:

  • Waiver of location requirements, including both geographic restrictions and originating site rules
  • Expanded list of eligible telehealth providers
  • Continued eligibility of Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) as Medicare telehealth providers
  • Delay of the prior in‑person visit requirement for mental health services when certain permanent telehealth policy requirements are not met
  • Delay of the in‑person visit requirement for mental health services delivered via telecommunications technology for FQHCs and RHCs
  • Continued allowance of audio‑only telehealth services
  • Continued use of telehealth to conduct face‑to‑face encounters for hospice recertification

In addition, the Acute Hospital Care at Home Initiative has been extended through September 30, 2030, allowing participating hospitals to continue providing hospital‑level care in patients’ homes.


Additional Telehealth Provisions in the Law

The legislation also includes several forward‑looking telehealth provisions that practices should be aware of:

  • CMS is required to establish billing modifiers by 2027 to identify telehealth services delivered through third‑party virtual platforms and services billed “incident to” another professional service.
  • Through calendar year 2027, hospitals may furnish and bill Medicare for cardiopulmonary rehabilitation services delivered to hospital outpatients in their homes via live video.
  • The Department of Health and Human Services must issue guidance within one year on best practices for delivering telehealth services to patients with limited English proficiency.
  • CMS is required to educate Medicare clinicians by January 1, 2028 on screening for medication‑induced movement disorders in at‑risk patients, including best practices for telehealth screening and how these services should be reflected in billing.

CMS Telehealth Guidance Updates

Following enactment of this legislation, CMS has updated its Telehealth FAQ for Calendar Year 2026 to reflect the restored flexibilities and new expiration dates.

The CMS Telehealth and Remote Patient Monitoring (RPM) Medicare Learning Network (MLN) Guidance, most recently revised in December 2025, remains a primary reference source. However, it has not yet been fully updated to reflect the most recent legislative changes. Some elements—such as references to an in‑person mental health visit within six months—will require revision, as that requirement is now waived through the end of 2027.

At the same time, several telehealth policy changes finalized under the CY 2026 Physician Fee Schedule (PFS) and reflected in the December 2025 MLN guidance remain in effect, as they were not addressed in H.R. 7148.


Telehealth Policies That Continue to Apply

Key provisions from the existing MLN guidance that remain unchanged include:

  • Permanent addition of new services to the Medicare Telehealth Services List, eliminating the former “provisional” versus “permanent” distinction
  • Removal of frequency limitations for subsequent inpatient visits, subsequent nursing facility visits, and critical care consultations
  • Allowance for teaching and supervising physicians to meet supervision requirements through virtual presence in appropriate clinical situations
  • Clarification of enrollment and billing rules for clinicians furnishing telehealth services from their homes, including options to suppress home address information in PECOS for privacy
  • Addition of new CPT and HCPCS codes to the Medicare Telehealth Services List, including codes for multiple‑family group psychotherapy, group behavioral counseling for obesity, certain infectious‑disease add‑on services, and auditory integrated sound processors

The MLN guidance also continues to reflect payment for telehealth services furnished by FQHCs and RHCs through December 31, 2026. Because the broader waivers have now been extended through 2027, FQHCs and RHCs remain eligible under the general waiver authority rather than relying on a more limited carve‑out.


DEA Extends Telehealth Prescribing Waiver Through 2026

Separately, the Drug Enforcement Administration (DEA) has extended the telehealth prescribing waiver for controlled substances through December 31, 2026. This extension allows prescribing without a prior in‑person visit or meeting a statutory exception and represents a clean, one‑year continuation with no new requirements.

This policy continues to suspend the initial in‑person visit requirement under the Ryan Haight Online Pharmacy Consumer Protection Act of 2008. The DEA’s rules apply nationwide and are separate from state requirements and Medicare reimbursement rules. Longer‑term federal prescribing policy remains unresolved, and additional changes may emerge.


How Northwest AHEC Can Help

Your Northwest AHEC Practice Support Team is here to help practices interpret telehealth policy changes and understand how they affect workflows, billing, and patient access. We encourage practices to stay informed through trusted resources like CCHP and to reach out with questions.

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New Upfront Claim Rejections Begin April 1, 2026: What Providers Need to Know

Feb 18, 2026 7:00:00 AM / by Practice Support Team posted in Billing

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Beginning April 1, 2026, several Medicaid managed care plans in North Carolina will change how certain claims are handled. Carolina Complete Health, Trillium Physical Health, and Partners Physical Health will move from post‑payment denials to upfront claim rejections when provider information on a claim is incorrect or incomplete.

This change applies broadly and will impact all provider types that submit claims—not just hospitals.


What’s Changing?

Under this new process, claims with provider data that does not match NCTracks will be rejected immediately, rather than processed and denied later.

Upfront rejections may occur when information such as:

  • National Provider Identifier (NPI)
  • Taxonomy
  • Rendering or billing provider details
  • Service location information

is missing, inactive, or does not align with what is on file in NCTracks.

If a claim is rejected upfront, it will not enter adjudication. Providers must correct the information and resubmit the claim.


Who Is Impacted?

These changes apply to ALL enrolled providers who submit claims, including:

  • Primary Care Providers (PCPs)
  • Medical and surgical specialists (cardiology, orthopedics, neurology, GI, OB/GYN, and others)
  • Behavioral health providers
  • Group practices
  • Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs)
  • Urgent care centers
  • Outpatient clinics
  • Ancillary providers (physical therapy, occupational therapy, speech therapy, labs, imaging centers)

If you submit claims, these rules apply to you.


Common Reasons Claims Will Be Rejected

Claims may be rejected upfront if any of the following issues are identified:

NPI Issues

  • NPI is not active with Medicaid or Health Choice for the date of service
  • NPI is not found on file
  • Required billing or rendering NPI is missing

Taxonomy Issues

  • Taxonomy does not match NCTracks enrollment
  • Taxonomy is not active for the date of service
  • Taxonomy is missing or invalid
  • Claim is billed under the wrong taxonomy

Service Location Issues

  • Service facility NPI is missing or inactive
  • Required service location fields are not completed when services are rendered at a location different from the billing address (e.g., CMS‑1500 Box 32/32a/32b)

What Providers Should Do Now

To reduce the risk of upfront rejections starting April 1, practices should take the following steps as soon as possible:

✅ Verify Your NCTracks Enrollment

Confirm that all of the following are current, active, and accurate in NCTracks:

  • Billing NPI
  • Rendering provider NPIs
  • Taxonomy codes
  • Service locations

✅ Bill Using the Correct Taxonomy

Ensure the taxonomy on your claim matches your NCTracks enrollment for the services being billed.

✅ Review Claim Form Accuracy

Double‑check that claim fields are completed correctly, including:

  • Billing provider information
  • Rendering provider information
  • Service facility location fields

✅ Use the Provider Billing Manual

Refer to the Carolina Complete Health Provider Billing Manual, particularly sections detailing:

  • Where NPIs must be reported
  • Where taxonomy codes must be placed
  • When service facility location fields are required

If You Receive an Upfront Rejection

If a claim is rejected upfront:

  1. Review the rejection code provided.
  2. Correct the provider information on the claim.
  3. Resubmit the claim.

No appeal is required for upfront rejections.

Designer (3)


A Note for Hospital Providers

In addition to upfront rejection changes, beginning April 15, 2026, hospital inpatient claims billed at $250,000 or more will move to pre‑payment review rather than post‑payment review. These reviews will continue to be conducted by 6 Degrees Health and apply to claims processed for Carolina Complete Health, Trillium Health Resources, and Partners Health Management.

Hospitals should be prepared to submit itemized bills proactively for high‑dollar inpatient claims to avoid processing delays.


Bottom Line

Starting April 1, 2026, accurate provider data matters more than ever.

These upfront rejection changes apply to all providers submitting claims. Ensuring that your NPI, taxonomy, rendering provider, and service location information exactly match what is on file in NCTracks is essential to avoid immediate claim rejections and payment delays.


How Practice Support Can Help

Your Northwest AHEC Practice Support Team is available to help practices:

  • Review common claim errors
  • Understand NCTracks enrollment alignment
  • Prepare billing staff for upcoming changes

If you have questions or would like assistance, please reach out to your local practice support coach.

 

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Medicaid Timeline for Corrected Payments & Claim Reprocessing

Feb 11, 2026 2:52:55 PM / by Practice Support Team posted in Medicaid, claims, payment

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What North Carolina Primary Care Practices Need to Know

 

North Carolina Medicaid has released updated guidance on when providers can expect corrected payments and claim reprocessing following the reversal of the Medicaid reimbursement rate reductions that took effect October 1, 2025.

We know this issue has created uncertainty for practice managers, billing teams, and financial planning. Below is a plain‑language summary of the timelines so you can plan appropriately and communicate clearly with your staff.


Background: What Changed?

On December 10, 2025, North Carolina announced the reversal of the Medicaid rate reductions implemented on October 1, 2025. These reversals apply to both NC Medicaid Direct (Fee‑for‑Service) and NC Medicaid Managed Care (PHPs).

The state has now outlined how and when corrected rates will be implemented and when affected claims will be reprocessed, as detailed in the NC Medicaid Rate Reduction Reversal Update.


Updated Fee Schedules

NC Medicaid has announced that updated fee schedules, reflecting the reversal of the October 1, 2025 rate reductions, are scheduled to be posted on January 5, 2026.

These updated fee schedules apply to:

  • NC Medicaid Direct (Fee‑for‑Service)
  • NC Medicaid Managed Care (PHP) plans

Updated schedules will be available through the NC Medicaid Fee Schedules and Covered Codes Portal.


When PHPs Will Implement Corrected Rates

Once the updated fee schedules are posted:

  • Prepaid Health Plans (PHPs have 45 days) to update their systems with the corrected rates.

This places PHP system implementation between January 5 and February 19, 2026, depending on the plan.

What this means for your practice

Providers should expect to begin seeing corrected Medicaid Managed Care (PHP) payments:

  • Mid‑February through early March 2026, depending on the PHP

Reprocessing of Previously Paid Claims

PHPs are required to reprocess all claims affected by the October 1, 2025 rate reductions for dates of service on or after October 1, 2025.

  • After implementing the corrected rates, PHPs have an additional 30 days to complete claim reprocessing.

Based on the required timelines, claim reprocessing is expected:

  • Late February through late March 2026
  • Some adjustments may extend into early April, depending on the PHP

Providers do not need to resubmit claims for reprocessing unless directed otherwise by their PHP.


NC Medicaid Direct (Fee‑for‑Service) Timeline

For comparison, NC Medicaid Direct (FFS) follows a different payment timeline.

Corrected payments for NC Medicaid Direct began appearing in the January 13, 2026 check write, following system updates tied to the January 5 fee schedule posting.

This differs from PHP timelines, which must follow the 45‑day system update period plus a 30‑day reprocessing window.


What Providers Should Expect — At a Glance

Medicaid Managed Care (PHPs):

  • Corrected payment amounts: Mid‑February through early March 2026
  • Reprocessed claim adjustments: Late February through March 2026
  • Some remittances may extend into early April, depending on the PHP

NC Medicaid Direct (FFS):

  • Corrected payments began January 13, 2026

What Practices Should Do Now

Continue submitting claims as usual
Monitor remittance advice carefully for adjustments and reprocessed claims
Prepare billing and finance staff for increased remittance activity over several weeks
Avoid duplicate resubmissions unless specifically instructed by the PHP

PHPs have indicated that providers do not need to take action for affected claims to be reprocessed.


Who This Applies To

This guidance applies to:

  • NC Medicaid Direct
  • NC Medicaid Managed Care (PHPs)

How Northwest AHEC Can Help

Your Northwest AHEC Practice Support Team is here to help practices navigate these changes. We can assist with:

  • Understanding remittance advice and claim adjustments
  • Preparing staff talking points and internal communications
  • Workflow planning during high‑volume claim reprocessing periods

If your practice has questions or would benefit from one‑on‑one support, please reach out to your local AHEC practice support coach.

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Paper CLIA Fee Coupons & Certificates Ending March 1, 2026

Feb 3, 2026 1:45:00 PM / by Practice Support Team posted in CMS, Laboratory Testing

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As part of our ongoing commitment to help practices stay ahead of regulatory changes, we want to make sure you’re aware of an important update from the Centers for Medicare & Medicaid Services (CMS) that may affect your laboratory operations—especially if your practice performs any in‑house testing.

What’s Changing?

CMS is modernizing the Clinical Laboratory Improvement Amendments (CLIA) program by transitioning entirely to electronic fee coupons and electronic CLIA certificates.

Starting March 1, 2026:

  • CMS will no longer mail paper CLIA fee coupons or CLIA certificates.
  • All CLIA certification and survey fees must be paid online.
    (Checks will no longer be accepted.)
  • Only practices and labs enrolled in CMS email notifications will receive fee coupons and certificates going forward.

This means it’s essential for laboratories and any provider conducting lab testing to be signed up for CMS electronic notifications before the March 1 deadline.

Why This Matters

Failure to transition to electronic notifications may result in:

  • Missed CLIA fee invoices
  • Lapsed certificates
  • Delays or disruptions in billing
  • Compliance issues that could affect laboratory testing services

We want your practice to avoid any of these preventable interruptions.

Action Steps for Practices

To continue receiving CLIA-related documents electronically, take one of the following steps as soon as possible:

  1. Email your State Agency
    Use the contact information provided in the CMS State Agency PDF to update or confirm your email address on file.

  2. Accredited Laboratories
    If your laboratory is accredited through an Accreditation Organization, contact your accreditor directly to update your email information.

Either option will ensure CMS has the correct email address for your lab or practice.

 

Steps to Look Up CLIA Status

  1. Access the Tool: Navigate to the QCOR Home Page and select "CLIA Laboratory Lookup" from the left-hand menu bar (typically the second option from the top).
  2. Enter Search Criteria: You can search for a laboratory using the following details:
    • CLIA Number: Enter the 10-digit alphanumeric identification number.
    • Facility Name: Use the full or partial name of the laboratory.
    • Location: Narrow results by City, State, or Zip Code.
  3. View Results: Click on the laboratory name in the search results to open a pop-up window containing demographics and status.
  4. Download Certificate: If a certificate was generated after September 27, 2023, a link to download the official PDF will be visible in the laboratory's information box. 

CMS Demographic Lookup: You can also check basic "active" lab information (expiration date, certificate type) on the CMS Laboratory Demographic Information page.

FDA CLIA Database: For information regarding specific test categorizations and waived analytes, use the FDA CLIA Database

How Practice Coaches Can Support You

We’re here to help your team prepare for the transition. Practice Support Coaches can:

  • Confirm whether your practice has already received electronic notifications
  • Help you identify your state agency contact
  • Walk through the steps to update your information
  • Answer questions about the process and how it may impact billing and operations

If your practice performs any point‑of‑care testing or maintains a CLIA certificate of waiver, this change applies to you—so please take a moment to complete this update.

Bottom Line

March 1, 2026 is the final cutoff for paper CLIA documents. Switching to electronic notifications now will help ensure seamless renewals, uninterrupted testing operations, and continued compliance with CMS requirements.

If you need assistance, don’t hesitate to reach out to your Practice Support Coach—we’re here to help you navigate the transition smoothly.

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Unlocking PHP Incentives in 2025–2026: What NC Practice Managers Need to Know Now

Jan 29, 2026 9:57:49 AM / by Practice Support Team

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Unlocking PHP Incentives in 2026: What NC Practice Managers Need to Know Now

January 28, 2026 — Practice Support Team

North Carolina’s Medicaid environment is shifting rapidly — and with those changes come new opportunities for practices to strengthen quality performance, support patient outcomes, and secure incentive‑based reimbursement. Whether your practice works with AmeriHealth Caritas, Healthy Blue, WellCare, UnitedHealthcare, or Carolina Complete Health, understanding both the current incentives and the upcoming 2026 standardized model is essential.

This post brings together key details from the major PHP programs — including Healthy Blue’s Healthy Rewards Program — along with insights from NC AHEC practice support coaches across the state. Our goal is simple: Help your practice claim every dollar it’s eligible for in 2026.


Why Incentives Matter More Than Ever

Medicaid PHP incentives directly support two major goals:

  • Improving quality and outcomes by encouraging completion of evidence‑based preventive and chronic‑care services.
  • Strengthening practice sustainability through reimbursement tied to performance and measurable care gaps closed.

One example is Healthy Blue’s Healthy Rewards Program, where members earn incentives for completing priority services such as:

  • Prenatal and postpartum care
  • Well‑child visits (0–30 months and 3–20 years)
  • Breast, cervical, and colorectal cancer screening
  • Diabetes A1c testing
  • Immunizations
  • Dental visits
  • Tobacco cessation counseling
  • Asthma medication adherence

When your practice completes these services and submits timely claims, patients earn rewards — and your practice earns quality credit and incentive payments.


What’s Changing in 2026 — and Why Preparation Matters

Beginning in 2026, NC Medicaid will implement the new Standardized AMH Performance Incentive Program. This statewide model will:

  • Use one statewide set of AMH quality measures
  • Standardize attribution and payment methodology
  • Align performance periods and reporting timelines
  • Eliminate PHP‑specific variations that burden practices
  • Simplify workflows for multi‑plan practices

This new model will simplify your work — but only if your practice prepares before the 2026 performance year begins.


Insights From NC AHEC Practice Support Coaches

Across NC AHEC regions, practice support coaches continue to hear the same themes:

1. Practices want clarity as Medicaid rules evolve.

Coaches help translate changing guidance, sharing up‑to‑date measure specifications and actionable workflows.

2. Practices that align workflows early see stronger results.

Teams that adjust scheduling, documentation, and billing processes early consistently outperform late adopters.

3. Many practices don’t realize they’re missing out on incentives.

AHEC coaches frequently uncover unclaimed incentive opportunities during dashboard reviews or chart audits.

4. Practices that partner with AHEC early adapt more smoothly.

Coaches help practices translate policy into practical workflows — from interpreting 2026 measures to troubleshooting billing issues.


Action Steps for NC Practice Managers

Here’s what your practice should begin doing now:

  1. Review all PHP incentive programs and align workflows.
    Confirm staff understand which services are incentivized and how to document them correctly.
  2. Submit claims promptly.
    Incentive payments and quality credit depend on timely, accurate submission.
  3. Educate patients about available rewards.
    Engaged patients complete more visits and help close more care gaps.
  4. Prepare staff for the statewide 2026 program.
    Design your strategy to adopt unified documentation and coding processes.
  5. Use your data.
    If you're unsure how you're performing, AHEC coaches can help review dashboards, attribution reports, or claims histories.

NC Medicaid PHP Patient Incentive Program Comparison (2026)

Including Healthy Blue, AmeriHealth, Carolina Complete Health, WellCare, and UnitedHealthcare

This comparison highlights:

  • Whether each PHP has a real incentive program
  • The reward model
  • Reward amounts
  • Annual caps
  • QI‑relevant categories (WCVs, maternity, screenings, chronic disease, behavioral health)

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Preparing for Change: A Guide to the Trillium Physical Health Network Transition

Jan 28, 2026 10:59:59 AM / by Practice Support Team posted in trillium

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Attention North Carolina Practice Managers:
If your practice operates within the Trillium Health Resources region, it is time to mark your calendars for July 1, 2026.
The Northwest AHEC Practice Support Team understands that administrative shifts in Medicaid contracting can feel like moving targets. Trillium has announced a significant update: they will soon directly manage their Physical Health and Long-Term Services and Support (LTSS) provider network, moving away from their current partnership with Carolina Complete Health.
Why the Change?
Trillium's goal is to foster more direct relationships with local providers. By moving to a unified claims system for Tailored Plan operations, they aim to:
  • Streamline billing and paperwork processes.
  • Enhance direct provider support.
  • Improve the overall efficiency of Tailored Plan operations.

What Your Practice Needs to Do Now
To ensure there is no disruption in your reimbursement or your ability to serve Trillium members, your practice must take proactive steps:
  1. Review the New Contract: Trillium is asking providers to sign a new Procurement Contract for Provision of Services. This can be signed quickly via DocuSign.
  2. Watch for Outreach from Andros: Trillium has partnered with Andros, a network management firm, to facilitate this transition. If you haven't already, expect to hear from them regarding contract amendments.
  3. Educational Resources: If you want a deeper dive into these changes, we recommend watching the Trillium Essentials - Section 1 video, which provides a walkthrough of these updates.
We Are Here to Support You
Navigating the nuances of Medicaid transformation in North Carolina is what we do best. If you have questions about how this specific transition impacts your workflow or credentialing, don't hesitate to reach out to the Northwest AHEC Practice Support Team.
For direct assistance from the transition team, you can also contact Andros at 1-800-694-3736 or via email at Trillium@Andros.com.
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What the Carolina Complete Health–WellCare Merger Means for Your Practice

Jan 21, 2026 10:30:00 AM / by Practice Support Team posted in Medicaid, Medicaid Managed Care, NCDHHS, Billing, practice support, practice management, medical provider, state health plan

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North Carolina Medicaid is entering a major new chapter. Carolina Complete Health (CCH) and WellCare of North Carolina will officially merge into a single statewide health plan on April 1, 2026. The new combined plan will operate under the Carolina Complete Health name and will serve all six NC Medicaid regions.

As your Northwest AHEC Practice Support Team, we’re here to break down what this means for your practice, your teams, and—most importantly—the North Carolinians you care for.


Why This Merger Matters

This transition creates North Carolina’s largest Medicaid health plan, covering more than 775,000 members across the state. The unified plan continues as a Provider-Led Entity (PLE)—meaning North Carolina physicians retain a central governance role.

For practices, this means:

  • Continued emphasis on provider voice in decision-making
  • Streamlined processes under one statewide plan
  • Reduced administrative duplication across CCH and WellCare products

Key Implementation Details You Need to Know

📅 Effective Date

April 1, 2026, unless NC DHHS issues updated guidance.


What This Means for Your Medicaid Patients

For current WellCare members

  • Automatically transitioned to Carolina Complete Health
  • No change in Medicaid benefits
  • Will receive a new Member Welcome Packet and Member ID card
  • Most members will keep their current primary care provider

For current Carolina Complete Health members

  • Coverage expands statewide from 3 to 6 regions
  • No change in Medicaid benefits
  • New CCH Member ID card will be mailed as part of annual re-card
  • Patients may keep their existing PCP

For Non-Members

Carolina Complete Health offers a free solution for payment by Electronic Funds Transfer (EFT) and Electronic Remittance Advice (835)/Explanation of Payment (ERA/EOP) through PaySpan®. If you are not already registered, create a new account by registering at payspanhealth.com or calling 1-877-331-7154, option 1.

For CCH providers

 The public website will remain https://network.carolinacompletehealth.com/. WellCare providers should begin using this webpage upon go-live (anticipated to be 4/1/2026) for updated materials (i.e. provider and billing manuals, contacts, and provider tools). 


What This Means for Your Practice

1. Contracting & Network Participation

  • If your practice is contracted with either CCH or WellCare, you will remain contracted with the merged entity.
  • To eliminate redundancy, the Medicaid product under WellCare agreements will be terminated as of April 1, 2026.
  • Providers will continue serving:
    • Medicaid & Tailored Plan members through the CCH agreement
    • Medicare members through the WellCare agreement

If you received termination notices tied to the Medicaid product, these apply only to the WellCare Medicaid portion—not your overall WellCare contract.


2. Member Reassignment & Market Share

CCH has clarified:

  • The new entity is not expected to exceed the market share cap
  • Providers should not see large-scale member panel reassignment due to the merger

3. Billing, Claims & EFT/ERA

Frequently asked questions from providers include:

  • EFT/ERA services will continue uninterrupted
  • Claims for dates of service before April 1, 2026 will follow the originating agreement (CCH or WellCare)
  • Claims on or after April 1, 2026 will process under the new CCH statewide plan

Updated provider manuals, billing guidance, and operations details will be posted on the official merger site as the go-live date approaches.


Operational Steps You Should Take Now

Verify provider directory listings

Ensure your practice’s information is correct across:

  • CCH Provider Directory
  • WellCare Provider Directory

Educate front‑desk and billing teams

Key items to emphasize:

  • New member ID cards
  • How to verify eligibility during the transition
  • Which plan to bill based on date of service

Review your contracts

Look specifically for:

  • CCH agreement terms
  • Any Medicaid-product termination notices from WellCare
  • Tailored Plan participation details (if applicable)

Monitor value-added service changes

Both CCH and WellCare note modifications coming to value-added services for 2026.


What Stays the Same

  • Medicaid benefits for members
  • Primary care provider assignments
  • Commitment to provider-led governance
  • NC Medical Society and NC Community Health Center Association remain partial owners of the Provider Led Entity (PLE)

Resources for Practice Managers

Here are the most relevant resources for keeping your team prepared:

Provider Merger FAQ (CCH Network Site)
https://network.carolinacompletehealth.com/merger.html


Member Merger Information (Public Site)
https://www.carolinacompletehealth.com/merger.html

Provider Services Contact:
1‑833‑552‑3876
NetworkRelations@CCH-Network.com

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Highlighted Resource: Adoption of Artificial Intelligence in the Health Care Sector

Jan 20, 2026 8:00:00 AM / by Practice Support Team posted in health care, artificial intelligence

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What are the trends in AI use in health care settings?

A recent JAMA article examines AI use in health care since 2023, and compares the changes in health care settings to wider AI use trends.

To learn more, check out the ADL’s January 15 Highlighted Resource: Adoption of Artificial Intelligence in the Health Care Sector

 

top view of Medicine doctor hand working with modern computer and smart phone on wooden desk as medical concept-Jan-20-2026-01-09-57-6119-PM

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NC Medicaid Updates Coverage for Psychiatric Collaborative Care Management

Jan 13, 2026 9:00:06 AM / by Practice Support Team posted in Medicaid, psychiatry, CoCM

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NC Medicaid has announced important updates to coverage for Psychiatric Collaborative Care Management (CoCM) services, effective December 31, 2025. This change impacts both NC Medicaid Direct and NC Medicaid Managed Care programs.


Key Update: End-Dating of HCPCS Code G0512

The Healthcare Common Procedure Coding System (HCPCS) code G0512 will be end-dated on Dec. 31, 2025. This means Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) must transition to reporting CoCM services using individual CPT and HCPCS codes that previously comprised G0512.

Per Centers for Medicare & Medicaid Services (CMS) guidance, the following codes should now be used:

  • 99492 – Initial psychiatric collaborative care management, first 70 minutes in the first calendar month.
  • 99493 – Subsequent psychiatric collaborative care management, first 60 minutes in a subsequent month of behavioral health care manager activities.
  • G2214 – Initial or subsequent psychiatric collaborative care management, first 30 minutes in a month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified healthcare professional.
  • 99494 – Initial or subsequent psychiatric collaborative care management, each additional 30 minutes in a calendar month (up to four 30-minute sessions allowed per month).

Why This Matters

This update ensures alignment with CMS requirements and supports accurate reporting for CoCM services. Providers should review their billing practices and update systems to reflect these changes before the effective date.


Background

This bulletin serves as an update to the Sept. 17, 2025 bulletin on Psychiatric Collaborative Care Management coverage. NC Medicaid continues to emphasize integrated behavioral health care and collaborative models to improve patient outcomes.


Action Steps for Providers

  • Discontinue use of G0512 after Dec. 31, 2025.
  • Begin reporting CoCM services using codes 99492, 99493, 99494, and G2214.
  • Ensure billing staff and systems are updated to comply with these changes.

For more details, visit the official NC Medicaid blog:
https://medicaid.ncdhhs.gov/blog/2025/12/30/updated-coverage-psychiatric-collaborative-care-management-december-30-2025

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Practice Support Update: NC Rural Health Transformation Program Launches with $213 Million in Federal Funding

Jan 8, 2026 8:00:00 AM / by Practice Support Team

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We’re excited to share a major development for rural health in North Carolina. Last week, the Centers for Medicare & Medicaid Services (CMS) approved North Carolina’s application for the Rural Health Transformation Program (RHTP)—a milestone that brings over $213 million in the first year to strengthen health care across our rural counties.

What Does This Mean for Your Practice?

  • Significant Investment: The RHTP will support nearly 3 million rural North Carolinians and strengthen more than 400 rural health facilities statewide.
  • Collaborative Approach: Implementation will involve state agencies, rural providers, community partners, academic institutions, and the private sector. This is a true team effort to improve health outcomes and care delivery.
  • Governance and Regional Hubs: Once funding is received, NCDHHS will quickly establish a statewide governance structure and begin building regional hubs. Stakeholders—including practices like yours—will be engaged in funding and implementation decisions.

Get Involved: Virtual Town Hall

NCDHHS is hosting a virtual town hall to share program goals, next steps, and the anticipated statewide impact:

  • Date: Friday, Jan. 16
  • Time: 2:30–3:30 p.m.
  • How to Join: Register using this link to attend via Zoom. You can also submit questions and join the RHTP mailing list during registration.

Why This Matters

  • Expanded Resources: Expect new opportunities for funding, technical assistance, and collaboration to address rural health challenges.
  • Practice Voice: Your input is needed! Participation in the town hall and ongoing engagement will help shape how resources are allocated and programs are implemented.
  • Stay Informed: For updates and more information, be sure to opt in for the mailing list when using the registration link above.

Next Steps for Practice Managers

  • Share this update with your teams and rural partners.
  • Register for the town hall and encourage your staff to participate.
  • Prepare questions or topics you’d like addressed—your feedback is essential.
  • Watch for further communications from NCDHHS and our coaching team as implementation details emerge.

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