---
title: Practice Support Services (4)
description: Health care practices in North Carolina face many challenges. Our quality improvement coaches (QICs) are trained to work with you to transform the way in which care is delivered in your practice. (4)
---

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# Practice Support Update Blog

## [New Upfront Claim Rejections Begin April 1, 2026: What Providers Need to Know](https://go.northwestahec.wakehealth.edu/practicesupport/new-upfront-claim-rejections-begin-april-1-2026-what-providers-need-to-know)

 Feb 18, 2026, 7:00:00 AM / by [Practice Support Team](https://go.northwestahec.wakehealth.edu/practicesupport/author/practice-support-team) posted in [Billing](https://go.northwestahec.wakehealth.edu/practicesupport/topic/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:](https://www.nctracks.nc.gov/content/public?version=NCTRACKS-Prod-DT20250625&why=Root)

- 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**,](https://network.carolinacompletehealth.com/resources/manuals-and-forms.html) 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)](https://go.northwestahec.wakehealth.edu/hs-fs/hubfs/Designer%20(3).png?width=1536&height=1024&name=Designer%20(3).png)

---

## 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.

 

[Read More](https://go.northwestahec.wakehealth.edu/practicesupport/new-upfront-claim-rejections-begin-april-1-2026-what-providers-need-to-know)

## [Medicaid Timeline for Corrected Payments & Claim Reprocessing](https://go.northwestahec.wakehealth.edu/practicesupport/medicaid-timeline-for-corrected-payments-claim-reprocessing)

 Feb 11, 2026, 2:52:55 PM / by [Practice Support Team](https://go.northwestahec.wakehealth.edu/practicesupport/author/practice-support-team) posted in [Medicaid](https://go.northwestahec.wakehealth.edu/practicesupport/topic/medicaid), [claims](https://go.northwestahec.wakehealth.edu/practicesupport/topic/claims), [payment](https://go.northwestahec.wakehealth.edu/practicesupport/topic/payment)

[0 Comments](https://go.northwestahec.wakehealth.edu/practicesupport/medicaid-timeline-for-corrected-payments-claim-reprocessing#comments-listing)

---

### 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](https://medicaid.ncdhhs.gov/blog/2025/12/19/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](https://ncdhhs.servicenowservices.com/fee_schedules).

---

## 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.

[Read More](https://go.northwestahec.wakehealth.edu/practicesupport/medicaid-timeline-for-corrected-payments-claim-reprocessing)

## [Highlighted Resource: Measles in North Carolina](https://go.northwestahec.wakehealth.edu/practicesupport/highlighted-resource-measles-in-north-carolina)

 Feb 4, 2026, 2:14:59 PM / by [Janice Moore, MLS](https://go.northwestahec.wakehealth.edu/practicesupport/author/janice-moore) posted in [Pediatric](https://go.northwestahec.wakehealth.edu/practicesupport/topic/pediatric), [measles](https://go.northwestahec.wakehealth.edu/practicesupport/topic/measles)

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Measles outbreaks have been occurring throughout the US, and North Carolina recorded its first recent case in December 2025. 

Health care providers need to be aware of the symptoms, treatments, and risks of this highly infectious disease.

To learn more, check out the ADL’s collection of Highlighted Resources: [NC Measles Metrics: a dashboard from the NC Department of Public Health](https://www.dph.ncdhhs.gov/programs/epidemiology/communicable-disease/infectious-respiratory-diseases/measles-rubeola/measles-cases-and-outbreaks-north-carolina#NumberofCasesReportedbyWeek-11520)

[What Practice Staff and Managers Need to Know about Measles: a tip sheet from NC AHEC’s Practice Support service line](https://public.3.basecamp.com/p/XQ548t65Z2o753ad77Tc8yto/upload/download/What%20Practice%20Staff%20and%20Managers%20Need%20to%20Know%20about%20Measles.pdf?disposition=attachment)

[What Parents Need to Know: patient-focused information from the American Academy of Pediatrics](https://www.healthychildren.org/English/health-issues/vaccine-preventable-diseases/Pages/Measles.aspx)

 

![Screenshot 2026-02-04 080010](https://go.northwestahec.wakehealth.edu/hs-fs/hubfs/Screenshot%202026-02-04%20080010.png?width=500&height=244&name=Screenshot%202026-02-04%20080010.png)

[Read More](https://go.northwestahec.wakehealth.edu/practicesupport/highlighted-resource-measles-in-north-carolina)

## [Paper CLIA Fee Coupons & Certificates Ending March 1, 2026](https://go.northwestahec.wakehealth.edu/practicesupport/paper-clia-fee-coupons-certificates-ending-march-1-2026)

 Feb 3, 2026, 1:45:00 PM / by [Practice Support Team](https://go.northwestahec.wakehealth.edu/practicesupport/author/practice-support-team) posted in [CMS](https://go.northwestahec.wakehealth.edu/practicesupport/topic/cms), [Laboratory Testing](https://go.northwestahec.wakehealth.edu/practicesupport/topic/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](https://www.cms.gov/regulations-and-guidance/legislation/clia/downloads/cliasa.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](https://qcor.cms.gov/main.jsp) 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](https://www.cms.gov/medicare/quality/clinical-laboratory-improvement-amendments/laboratory-registry) page.

**FDA CLIA Database:** For information regarding specific test categorizations and waived analytes, use the [FDA CLIA Database](https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfclia/search.cfm). 

### **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.

[Read More](https://go.northwestahec.wakehealth.edu/practicesupport/paper-clia-fee-coupons-certificates-ending-march-1-2026)

## [Unlocking PHP Incentives in 2025–2026: What NC Practice Managers Need to Know Now](https://go.northwestahec.wakehealth.edu/practicesupport/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](https://go.northwestahec.wakehealth.edu/practicesupport/author/practice-support-team)

[0 Comments](https://go.northwestahec.wakehealth.edu/practicesupport/unlocking-php-incentives-in-2025-2026-what-nc-practice-managers-need-to-know-now#comments-listing)

# 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)

[Read More](https://go.northwestahec.wakehealth.edu/practicesupport/unlocking-php-incentives-in-2025-2026-what-nc-practice-managers-need-to-know-now)

## [Preparing for Change: A Guide to the Trillium Physical Health Network Transition](https://go.northwestahec.wakehealth.edu/practicesupport/preparing-for-change-a-guide-to-the-trillium-physical-health-network-transition)

 Jan 28, 2026, 10:59:59 AM / by [Practice Support Team](https://go.northwestahec.wakehealth.edu/practicesupport/author/practice-support-team) posted in [trillium](https://go.northwestahec.wakehealth.edu/practicesupport/topic/trillium)

[0 Comments](https://go.northwestahec.wakehealth.edu/practicesupport/preparing-for-change-a-guide-to-the-trillium-physical-health-network-transition#comments-listing)

**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](https://www.trilliumhealthresources.org/physical-health-contracts) 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](https://www.trilliumhealthresources.org/physical-health-contracts). This can be signed quickly via DocuSign.
2. **Watch for Outreach from Andros:** Trillium has partnered with [Andros](https://www.trilliumhealthresources.org/physical-health-contracts), 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](https://www.google.com/search?q=https://vimeo.com/1140497020/023b377f88%3F%26login%3Dtrue%23_%3D_) 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](mailto:Trillium@Andros.com).

[Read More](https://go.northwestahec.wakehealth.edu/practicesupport/preparing-for-change-a-guide-to-the-trillium-physical-health-network-transition)

## [What Practice Staff and Managers Need to Know About Measles as Cases Rise in North Carolina](https://go.northwestahec.wakehealth.edu/practicesupport/what-practice-staff-and-managers-need-to-know-about-measles-as-cases-rise-in-north-carolina)

 Jan 22, 2026, 9:05:00 AM / by [Chris Jones, DrPH](https://go.northwestahec.wakehealth.edu/practicesupport/author/chris-jones) posted in [infection](https://go.northwestahec.wakehealth.edu/practicesupport/topic/infection), [measles](https://go.northwestahec.wakehealth.edu/practicesupport/topic/measles), [infectious disease](https://go.northwestahec.wakehealth.edu/practicesupport/topic/infectious-disease)

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As measles cases continue to rise across North Carolina and the surrounding region, it’s important for practice staff and managers to be equipped with clear, up‑to‑date information. This guidance combines essential material from the **Measles Patient FAQ (Jan. 15, 2026)** and reporting from **North Carolina Health News**, tailored specifically for frontline teams and leaders working to maintain high‑quality, safe clinical environments.

We encourage all practices to review the details below and share them with their teams.

---

## **What Is Measles?**

Measles is a highly contagious viral illness that spreads quickly in unvaccinated populations. Early symptoms include:

- High fever (often \>104°F)
- Cough
- Runny nose
- Red or watery eyes
- A rash starting on the face, spreading downward
- Small white mouth spots (Koplik’s spots) [\[Debrief Re...Ethics\_v2 | PowerPoint\]](https://carolinashealthcare-my.sharepoint.com/personal/christopher_jones3_advocatehealth_org/_layouts/15/Doc.aspx?sourcedoc=%7B6B4A4BEC-222F-0449-4161-D0326F59107C%7D&file=Debrief%20Report_Pilot%201of4_Exploring%20Ethics_v2.pptx&action=edit&mobileredirect=true&DefaultItemOpen=1)

Measles can cause severe complications—especially among children, older adults, and immunocompromised patients—making early identification essential in clinical settings.

---

## **How It Spreads — and Why Practices Should Stay Alert**

The measles virus can remain airborne for **up to two hours** after an infected person leaves the area. Approximately **90% of unvaccinated individuals** exposed will become infected. [\[Debrief Re...Ethics\_v2 | PowerPoint\]](https://carolinashealthcare-my.sharepoint.com/personal/christopher_jones3_advocatehealth_org/_layouts/15/Doc.aspx?sourcedoc=%7B6B4A4BEC-222F-0449-4161-D0326F59107C%7D&file=Debrief%20Report_Pilot%201of4_Exploring%20Ethics_v2.pptx&action=edit&mobileredirect=true&DefaultItemOpen=1)

Given this high infectivity, even a brief clinic exposure may require rapid response and coordinated communication with public health partners.

---

## **Why North Carolina Is Seeing More Cases**

Recent reporting from *North Carolina Health News* highlights a continued rise in statewide measles cases, many linked to the **ongoing outbreak in Spartanburg County, SC**. Key takeaways include:

- Cases in NC have increased since December, primarily among **unvaccinated children**.
- Early symptoms may not be recognized immediately, allowing unintentional spread.
- The two‑dose MMR vaccine remains the most reliable prevention tool. [\[northcarol...thnews.org\]](https://www.northcarolinahealthnews.org/2026/01/16/10-things-to-know-about-measles-as-cases-rise-in-north-carolina/)

For practice leaders, this underscores the importance of reinforcing vaccination outreach, screening protocols, and rapid response workflows.

---

## **MMR Vaccination Guidance for Patients**

Vaccination remains the strongest protection.

### **Standard schedule**

- **First dose:** 12–15 months
- **Second dose:** 4–6 years [\[Debrief Re...Ethics\_v2 | PowerPoint\]](https://carolinashealthcare-my.sharepoint.com/personal/christopher_jones3_advocatehealth_org/_layouts/15/Doc.aspx?sourcedoc=%7B6B4A4BEC-222F-0449-4161-D0326F59107C%7D&file=Debrief%20Report_Pilot%201of4_Exploring%20Ethics_v2.pptx&action=edit&mobileredirect=true&DefaultItemOpen=1)

### **Adult considerations**

Most adults with two documented doses do **not** need a booster; those uncertain should speak with their provider. Immunity testing is **not recommended** for those with two recorded doses. [\[Debrief Re...Ethics\_v2 | PowerPoint\]](https://carolinashealthcare-my.sharepoint.com/personal/christopher_jones3_advocatehealth_org/_layouts/15/Doc.aspx?sourcedoc=%7B6B4A4BEC-222F-0449-4161-D0326F59107C%7D&file=Debrief%20Report_Pilot%201of4_Exploring%20Ethics_v2.pptx&action=edit&mobileredirect=true&DefaultItemOpen=1)

### **In outbreak areas**

Providers may consider early second doses or early infant vaccination (6–12 months), depending on risk. [\[Measles Patient FAQ | PDF\]](https://carolinashealthcare-my.sharepoint.com/personal/christopher_jones3_advocatehealth_org/Documents/Microsoft%20Copilot%20Chat%20Files/Measles%20Patient%20FAQ.pdf)

---

## **Exposure Guidance to Share with Patients**

Your **local health department** determines what meets the criteria for exposure.

### **If vaccinated (2 doses) or born before 1957:**

- No post‑exposure treatment
- No work restrictions
- Monitor for symptoms days **5–21**
- Call the clinic or health department if symptoms appear [\[Debrief Re...Ethics\_v2 | PowerPoint\]](https://carolinashealthcare-my.sharepoint.com/personal/christopher_jones3_advocatehealth_org/_layouts/15/Doc.aspx?sourcedoc=%7B6B4A4BEC-222F-0449-4161-D0326F59107C%7D&file=Debrief%20Report_Pilot%201of4_Exploring%20Ethics_v2.pptx&action=edit&mobileredirect=true&DefaultItemOpen=1)

### **If unvaccinated, unsure, or immunocompromised:**

- May require prophylaxis
- Stay home **days 5–21** after exposure
- Contact healthcare provider promptly with any symptoms [\[Debrief Re...Ethics\_v2 | PowerPoint\]](https://carolinashealthcare-my.sharepoint.com/personal/christopher_jones3_advocatehealth_org/_layouts/15/Doc.aspx?sourcedoc=%7B6B4A4BEC-222F-0449-4161-D0326F59107C%7D&file=Debrief%20Report_Pilot%201of4_Exploring%20Ethics_v2.pptx&action=edit&mobileredirect=true&DefaultItemOpen=1)

---

## **Guidance for Managing Pediatric Populations**

When coaching your teams, emphasize:

- **Infants 0–6 months:** Avoid exposure entirely
- **Infants 6–12 months:** Discuss early MMR dose when appropriate
- **Children with one dose:** Consider early second dose during outbreaks
- **Unvaccinated children:** Begin the MMR series immediately [\[Measles Patient FAQ | PDF\]](https://carolinashealthcare-my.sharepoint.com/personal/christopher_jones3_advocatehealth_org/Documents/Microsoft%20Copilot%20Chat%20Files/Measles%20Patient%20FAQ.pdf)

If measles is suspected, **have families call before arrival** so your clinic can prepare isolation precautions. [\[Measles Patient FAQ | PDF\]](https://carolinashealthcare-my.sharepoint.com/personal/christopher_jones3_advocatehealth_org/Documents/Microsoft%20Copilot%20Chat%20Files/Measles%20Patient%20FAQ.pdf)

---

## **Testing, Treatment & Clinical Considerations**

There is **no antiviral treatment** for measles. Vitamin A may be used in treatment **after** infection but does not prevent illness. Only the MMR vaccine prevents disease. [\[wunc.org\]](https://www.wunc.org/health/2026-01-21/measles-north-carolina-tracking-dashboard)

Practices should reinforce workflows for:

- Prompt masking and isolation
- Airborne precautions where possible
- Immediate notification of Infection Prevention or public health partners
- Reviewing room‑closure procedures for airborne pathogens

---

## **Recommended Webinar for Staff Education**

To support your quality improvement efforts, we encourage you and your teams to watch this short webinar on measles preparedness:

👉 [**Webinar: Measles Overview & Preparedness Strategies**](https://www.youtube.com/watch?v=c7XaR4QSids)

Include this resource in your next staff meeting or circulate it through internal communication channels.

---

## **Final Notes for Practice Leaders**

As your AHEC Practice Support team, we encourage practices to:

- Review vaccination outreach strategies for gaps
- Reassess triage and front‑desk screening workflows
- Reinforce airborne isolation procedures
- Ensure your team understands exposure timelines and reporting expectations
- Share this blog post with all team members, including supervisors and clinical staff

Measles remains **highly preventable**, and strong practice‑level systems make a meaningful difference in patient and community safety.

If you’d like help conducting a workflow assessment, staff training, or readiness review, your NC AHEC Practice Support coach is here to help.

[Read More](https://go.northwestahec.wakehealth.edu/practicesupport/what-practice-staff-and-managers-need-to-know-about-measles-as-cases-rise-in-north-carolina)

## [What the Carolina Complete Health–WellCare Merger Means for Your Practice](https://go.northwestahec.wakehealth.edu/practicesupport/what-the-carolina-complete-health-wellcare-merger-means-for-your-practice)

 Jan 21, 2026, 10:30:00 AM / by [Practice Support Team](https://go.northwestahec.wakehealth.edu/practicesupport/author/practice-support-team) posted in [Medicaid](https://go.northwestahec.wakehealth.edu/practicesupport/topic/medicaid), [Medicaid Managed Care](https://go.northwestahec.wakehealth.edu/practicesupport/topic/medicaid-managed-care), [NCDHHS](https://go.northwestahec.wakehealth.edu/practicesupport/topic/ncdhhs), [Billing](https://go.northwestahec.wakehealth.edu/practicesupport/topic/billing), [practice support](https://go.northwestahec.wakehealth.edu/practicesupport/topic/practice-support), [practice management](https://go.northwestahec.wakehealth.edu/practicesupport/topic/practice-management), [medical provider](https://go.northwestahec.wakehealth.edu/practicesupport/topic/medical-provider), [state health plan](https://go.northwestahec.wakehealth.edu/practicesupport/topic/state-health-plan)

[0 Comments](https://go.northwestahec.wakehealth.edu/practicesupport/what-the-carolina-complete-health-wellcare-merger-means-for-your-practice#comments-listing)

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](https://www.payspanhealth.com/nps)or calling 1-877-331-7154, option 1.

### For CCH providers

 The public website will remain [https://network.carolinacompletehealth.com/](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)  
https://network.carolinacompletehealth.com/merger.html

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

**Provider Services Contact:**  
1‑833‑552‑3876  
[NetworkRelations@CCH-Network.com](mailto:NetworkRelations@CCH-Network.com)

[Read More](https://go.northwestahec.wakehealth.edu/practicesupport/what-the-carolina-complete-health-wellcare-merger-means-for-your-practice)

## [Influence Future Training Opportunities](https://go.northwestahec.wakehealth.edu/practicesupport/influence-future-training-opportunities)

 Jan 21, 2026, 8:30:00 AM / by [Brooke Kochanski](https://go.northwestahec.wakehealth.edu/practicesupport/author/brooke-kochanski) posted in [continuing education](https://go.northwestahec.wakehealth.edu/practicesupport/topic/continuing-education), [health professionals](https://go.northwestahec.wakehealth.edu/practicesupport/topic/health-professionals)

[0 Comments](https://go.northwestahec.wakehealth.edu/practicesupport/influence-future-training-opportunities#comments-listing)

Northwest AHEC and the Office of Continuing Medical Education collaborate with state and local health associations, universities and community colleges, and hospitals and community organizations to serve constituents in the Northwest AHEC 17-county region and across the state. We offer educational activities designed to enhance knowledge and refresh clinical and professional skills.

**--\> Please take about 5 minutes to **[**complete this needs assessment**](https://evaluations.ncahec.net/s3/2026-CPD-Needs-Assessment-Survey)**.**

 

**We value your feedback and planning for future activities will be based on your input, survey deadline is January 28****th****.**

**![Your Feedback Matters placard with bokeh background-2](https://go.northwestahec.wakehealth.edu/hs-fs/hubfs/Your%20Feedback%20Matters%20placard%20with%20bokeh%20background-2.jpeg?width=300&height=211&name=Your%20Feedback%20Matters%20placard%20with%20bokeh%20background-2.jpeg)**

[Read More](https://go.northwestahec.wakehealth.edu/practicesupport/influence-future-training-opportunities)

## [Highlighted Resource: Adoption of Artificial Intelligence in the Health Care Sector](https://go.northwestahec.wakehealth.edu/practicesupport/highlighted-resource-adoption-of-artificial-intelligence-in-the-health-care-sector)

 Jan 20, 2026, 8:00:00 AM / by [Practice Support Team](https://go.northwestahec.wakehealth.edu/practicesupport/author/practice-support-team) posted in [health care](https://go.northwestahec.wakehealth.edu/practicesupport/topic/health-care), [artificial intelligence](https://go.northwestahec.wakehealth.edu/practicesupport/topic/artificial-intelligence)

[0 Comments](https://go.northwestahec.wakehealth.edu/practicesupport/highlighted-resource-adoption-of-artificial-intelligence-in-the-health-care-sector#comments-listing)

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](https://jamanetwork.com/journals/jama-health-forum/fullarticle/2841460)

 

![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](https://go.northwestahec.wakehealth.edu/hs-fs/hubfs/top%20view%20of%20Medicine%20doctor%20hand%20working%20with%20modern%20computer%20and%20smart%20phone%20on%20wooden%20desk%20as%20medical%20concept-Jan-20-2026-01-09-57-6119-PM.jpeg?width=300&height=200&name=top%20view%20of%20Medicine%20doctor%20hand%20working%20with%20modern%20computer%20and%20smart%20phone%20on%20wooden%20desk%20as%20medical%20concept-Jan-20-2026-01-09-57-6119-PM.jpeg)

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- [heart health (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/heart-health)
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- [infectious disease (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/infectious-disease)
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- [phishing (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/phishing)
- [physical therapy (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/physical-therapy)
- [physician assistant (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/physician-assistant)
- [prediabetes (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/prediabetes)
- [prior authorizations (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/prior-authorizations)
- [race (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/race)
- [referral (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/referral)
- [regulations (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/regulations)
- [remote patient monitoring (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/remote-patient-monitoring)
- [research (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/research)
- [respiratory care (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/respiratory-care)
- [rn refresher (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/rn-refresher)
- [safety (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/safety)
- [scope of practice (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/scope-of-practice)
- [shelter (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/shelter)
- [smoking (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/smoking)
- [support staff (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/support-staff)
- [surgery (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/surgery)
- [surgical services (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/surgical-services)
- [team based care (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/team-based-care)
- [therapy (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/therapy)
- [training (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/training)
- [transgender (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/transgender)
- [tricare (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/tricare)
- [trillium (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/trillium)
- [united healthcare (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/united-healthcare)
- [virtual (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/virtual)
- [winston-salem (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/winston-salem)
- [winter (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/winter)

See all

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# About Us

The Northwest Area Health Education Center of Wake Forest University School of Medicine provides and supports educational activities and services with a focus on primary care in rural communities and those with less access to resources to recruit, train and retain the workforce needed to create a healthy North Carolina.

[Learn More](https://school.wakehealth.edu/Education-and-Training/Continuing-Professional-Education/Northwest-AHEC)

# Links

- [Course Catalog](http://nwahec.org/)
- [Join Our Email List](https://share.hsforms.com/16F72ZaBBRBqAda7M--9l9w4ewk6)
- [About Northwest AHEC](https://school.wakehealth.edu/education-and-training/continuing-professional-education/northwest-ahec)
- [Continuing Education Services](https://school.wakehealth.edu/education-and-training/continuing-professional-education/northwest-ahec/continuing-professional-development)
- [Contact Support](https://go.northwestahec.wakehealth.edu/support)

# Contact Us

[ahecmktg@wakehealth.edu](mailto:ahecmktg@wakehealth.edu)

 Medical Center Boulevard  
 Winston-Salem, North Carolina

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