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.

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)

• Streamline billing and paperwork processes.
• Enhance direct provider support.
• Improve the overall efficiency of Tailored Plan operations.

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.

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

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

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

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.

Happy New Year, North Carolina Practice Managers and Staff!

As we begin 2026, the landscape of childhood immunizations is shifting—bringing both confusion and opportunity for clarity. The latest update from the CDC, following a Presidential directive to align U.S. recommendations with “peer nations” like Denmark, has resulted in significant changes to the recommended vaccine schedule for children. Here’s what you need to know, and how to support your teams and families through this transition.

What’s Changed?

• Fewer Routine Vaccines: The CDC now routinely recommends vaccines for 11 diseases instead of 17. For example, the HPV vaccine moves from a 2-dose to a 1-dose schedule.
• Risk-Based & Shared Decision-Making: Several vaccines previously recommended for all children are now either:
  • Recommended only for high-risk groups: RSV (for children whose mothers didn’t get the pregnancy vaccine), Hepatitis A, Hepatitis B, Meningococcal.
  • Left to “shared clinical decision-making” (SCDM): Rotavirus, COVID-19, Influenza, Hepatitis A, Hepatitis B, Meningococcal. This means clinicians and families decide together, based on individual risk and benefit.
• No Change for Pediatric Vaccines Coverage: Medicaid and Prepaid Health Plans (PHPs) have not changed their position—coverage for pediatric vaccines remains unchanged at this time.

New HHS Childhood Immunization Schedule (Released January 5, 2026)

Key Points for Your Practice

1. Access Remains: Families can still access the full range of childhood immunizations recommended by the American Academy of Pediatrics (AAP) and American Academy of Family Physicians (AAFP). The AAP schedule remains unchanged and is available .
2. No Out-of-Pocket Cost: All vaccines—including those now under SCDM—are still covered with no out-of-pocket cost by ACA-regulated private insurance, Medicaid, and the Vaccines for Children (VFC) program. HHS has affirmed this commitment.
3. Evidence Is Unchanged: The scientific evidence supporting the full AAP and AAFP vaccination schedules remains robust. These changes do not reflect new safety or efficacy concerns.
4. Anticipate Challenges: Expect confusion and operational challenges around school vaccine requirements, clinical workflows, and supply of combination vaccines. Clear communication and updated workflows will be essential.

Practical Guidance for Practice Managers & Staff

• Continue to Offer and Recommend Vaccines: Pediatricians and primary care teams can still offer vaccines according to the evidence-based U.S. schedule. Parents can request them, and clinicians should reassure families about continued access and coverage.
• Update Clinical Workflows: Integrate prompts and education into EHRs and point-of-care tools to maintain routine vaccination workflows and avoid missed opportunities.
• Communicate Clearly: Use talking points that focus on health outcomes (illnesses prevented, hospitalizations avoided) rather than the number of vaccines. Emphasize that fewer vaccines does not mean better health outcomes.
• Monitor for Policy Updates: Stay tuned for further guidance from NC Medicaid, VFC, and state health agencies. Forward any updates you receive to the NC Immunization Coalition (NCIC) and share with your teams.
• Educate Staff and Families: Address misconceptions proactively. For example:
  • The U.S. is not an outlier—most peer nations have schedules similar to ours, not Denmark’s.
  • The broader U.S. schedule exists to fill gaps in healthcare access and disease screening.
  • The Hep B birth dose is a critical safety net, especially given gaps in maternal screening and follow-up in the U.S.
  • Combination vaccines help reduce the number of shots, not the level of protection.

North Carolina Secures $213 Million to Transform Rural Health Care

We’re excited to share a major milestone for rural health in North Carolina. The Centers for Medicare & Medicaid Services (CMS) has approved North Carolina’s application for the Rural Health Transformation Program (RHTP), unlocking over $213 million in first-year funding to strengthen health care delivery across 85 rural counties.

This achievement reflects collaboration with more than 420 stakeholders, including rural hospitals, community health centers, local health departments, Tribal communities, and community- and faith-based organizations. It underscores North Carolina’s long-standing commitment to ensuring rural residents have access to high-quality, affordable care.

Why This Matters

North Carolina has the second-largest rural population in the nation, facing unique challenges in access, workforce, and infrastructure. The RHTP introduces six key strategies to address these needs:

• Expand behavioral health services
• Invest in the rural health workforce
• Improve prevention and chronic disease management
• Support providers transitioning to value-based care
• Enhance health care technology
• Launch NC ROOTS Hubs to connect medical, behavioral health, and social supports

What’s Next

Implementation will involve a broad coalition of state agencies, rural providers, community partners, academic institutions, and the private sector. Once funding is received, NCDHHS will:

• Establish a statewide governance structure
• Begin building regional hubs
• Engage stakeholders in funding and implementation decisions

To keep the conversation going, NCDHHS will host a virtual town hall on Friday, Jan. 16 to share program goals, next steps, and statewide impact. Details and registration will be available soon on the https://www.ncdhhs.gov.

Impact at a Glance

• Nearly 3 million rural North Carolinians supported
• More than 400 rural health facilities strengthened
• $213 million in federal investment for year one

This is a transformative moment for rural health in North Carolina, and we look forward to working together to make it a success.

Would you like me to make this more conversational and blog-friendly (with a warm tone and call-to-action), or keep it formal and policy-focused for professional audiences?