Effective July 1, 2026, Trillium Health Resources, a leading specialty care manager (LME/MCO) for individuals with serious behavioral health, intellectual/developmental disabilities, and traumatic brain injury in North Carolina, will implement a major enhancement to streamline operations for providers across its Tailored Plan. The organization is transitioning to a unified claims system, designed to simplify processes and improve efficiency for all stakeholders.
Under this new approach, all providers—including those delivering behavioral health, physical health, and long-term services and supports (LTSS)—will submit claims through a single, centralized portal. This change eliminates the need for multiple systems, reducing administrative burden and creating a more seamless experience for providers.
Why This Change Matters
Moving to a unified claims system ensures:
- Consistency in claims processing across all service types.
- Reduced administrative complexity for providers.
- Improved transparency and faster resolution of claims issues.
Provider Support Resources
Trillium offers comprehensive tools and contact points to assist providers during this transition:
- Provider Portals
Access claims submission, eligibility verification, and authorization tools through the secure provider portal. - Contact Directory
Find dedicated phone numbers and email addresses for provider relations, claims assistance, and technical support in the contact directory. - Training & Guidance
Explore manuals, FAQs, and step-by-step instructions for portal navigation and claims processes via training and guidance section. - Specialized Support
Separate contact options for behavioral health, physical health, and LTSS services ensure tailored assistance. Details are available on the contact and information portal.
Actionable Tips for Providers
- Review Current Processes – Identify workflows impacted by the new portal.
- Train Your Staff – Use Trillium’s guides and recorded webinars.
- Set Up Portal Access Early – Complete registration as soon as instructions are released.
- Update Compliance Documentation – Align policies with new requirements.
- Stay Connected – Subscribe to provider bulletins and attend office hours.
Next Steps for Providers
- Mark Your Calendar: The unified claims system goes live on July 1, 2026.
- Attend Training: Watch for announcements about upcoming webinars and office hours.
- Stay Informed: Review provider bulletins and subscribe to Trillium updates.
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.
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ACCESS Model: What You Need to Know
Last week, CMS launched important information about the Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model, and we want to make sure your practice is ready to take advantage of this opportunity.
Key Highlights
- Launch Date: July 1, 2026
- Duration: 10-year voluntary program within Original Medicare
- Goal: Improve care for conditions that affect millions of beneficiaries through innovative, scalable solutions.
Four Clinical Tracks
The ACCESS Model focuses on:
- Early Cardio-Kidney-Metabolic (CKM) Conditions
Hypertension, high cholesterol, obesity, and prediabetes. - Established CKM Disease
Diabetes, chronic kidney disease, and heart disease. - Musculoskeletal Chronic Pain
- Behavioral Health
Depression and anxiety.
Flexibility for Your Practice
Here’s the good news: You can participate in just one component. For example, if your team is ready to start with reporting depression and anxiety measures, that’s an option. This flexibility makes it easier for practices to engage without overhauling all workflows at once.
Why This Matters
- Better Outcomes: Supports proactive, coordinated care for chronic conditions.
- Practice Growth: Positions your team as a leader in value-based care.
- Patient Engagement: Helps address behavioral health needs alongside physical health.
Next Steps
- Learn More: Review CMS details here
- Assess Readiness: Identify which track aligns best with your patient population.
- Plan Ahead: Start conversations with your team about workflows for reporting measures.
Welcome to Your 2025 Wrapped
If 2025 were a playlist, it would be an epic mix of resilience, innovation, and hard work. As we close out the year, we wanted to take a moment to look back at the "music" we made together.
This year, practice managers and staff across our region didn't just keep the rhythm—you set the tempo for better healthcare in Northwest North Carolina. From navigating complex payer changes to launching new care models, you turned challenges into chart-topping successes.
Here is what your year sounded like, according to the numbers.
📊 The "Minutes Listened" (Our Impact by the Numbers)
You were incredibly busy this year. While much of the healthcare world was just tuning in, you were logging serious hours to improve access and quality.
- Total Practice Coaching Encounters: 2,297
- That represents nearly 2,300 specific touchpoints where we worked side-by-side with you to solve problems and improve care.
- Top Region on the Charts: Ashe County ⛰️
- Ashe County was our "Top Artist" this year with 164 encounters, proving that rural health remains the heartbeat of our region.
- The Rising Hits:
- Alleghany and Alexander counties also topped the setlist, keeping the momentum strong across our footprint.
🎹 Your Top Genre: Medicaid Managed Care
If 2025 had a main genre, it was definitely Medicaid Managed Care.
Just like in previous years, this was the beat driving most of our work. Whether it was deciphering the Standardized Performance Incentive Program or navigating Advanced Medical Home (AMH) tier support, you stayed in sync with the state's biggest changes.
Your Top Sub-Genres (Trending Topics):
- Billing & Coding: The technical solos that kept your revenue cycle moving.
- Practice Management Operations: The daily rhythm of running an efficient office.
- Quality Payment Program (QPP): The critical performance reviews that ensured you got credit for your quality care.
💿 The "Viral Hits" (Top Stories of 2025)
Every year has those standout tracks that everyone talks about. These were the success stories and resources that defined 2025 for our network.
The Breakout Group: Twin City Pediatrics 🌟- The Story: Facing a surge in mental health needs, the team at Twin City Pediatrics implemented the Collaborative Care Model (CoCM).
- The Result: By June 2025, they didn't just launch—they became revenue-positive six months ahead of schedule. It was the feel-good hit of the summer and a blueprint for others to follow.
The Community Anthem: Rural Health Center Visits 
- The Story: Throughout the year, NWAHEC's partnership with the Office of Rural Health (ORH) focused on supporting State Designated Rural Health Centers. This collaboration was vital in ensuring top-notch primary healthcare for all residents in their communities.
- The Vibe: We were delighted to work with true community anchors, including Grace Clinic in Elkin, Surry Medical Ministries in Mt Airy, and Hugh Chatham, who truly strive to address their communities' needs. This project embodies the core of our practice support mission.
The Indie Favorite: Fall Risk Assessment
- The Story: Released in June, the self-paced course Falls: Screening, Risk Assessment and Care Planning became an instant essential for clinicians working with older adults.
- The Vibe: Since its debut on 6/16/25, it has racked up 223 registrations. By focusing on the STEADI framework, you proved that keeping patients safe and steady is a timeless classic that never goes out of style.
- The Story: With the announcement that the Clear Pricing Project ends on Dec 31, 2025, we shifted focus to transition planning.
- The Shift: You worked hard to prepare for the move away from CPP and into new fee schedules for 2026, ensuring your practices remain financially stable during the switch.
🔮 Your "Musical Aura" for 2026
Based on your listening habits late in the year, 2026 is shaping up to be a year of Innovation & Resilience.
We are already queuing up tracks on AI in Clinical Decisions, Cybersecurity, and leveraging the newly relaunched NC AHEC Digital Library. The setlist for next year is going to be exciting, and we can't wait to explore it with you.
Thank you for a chart-topping 2025!
Here’s to keeping the beat going in the New Year.
— The NW AHEC Practice Support Team
Need help planning your 2026 playlist? Reach out to us at practicesupport@wakehealth.edu.
North Carolina needs primary care clinicians to support the state’s rapidly growing population, and the Primary Care Clinician Index from the Sheps Center tracks changes in the healthcare workforce. This recent article in the NC Medical Journal discusses the changes that this index shows in the NC healthcare workforce, highlighting the statewide patterns in clinician location and type.
To learn more, check out the ADL’s December 1 Highlighted Resource: Unpacking the Primary Care Clinician Index: Understanding How Changes in Population and Workforce Supply Affect Access to Primary Care in North Carolina
For more on health factors in NC, check out the latest issue of the NC Medical Journal: Turning the Curve: Halfway to Healthy North Carolina 2030
We’re excited to invite you to the last Community Health Worker (CHW) Integration Workgroup meeting of the year on:
📅 Date: Tuesday, December 9, 2025
🕑 Time: 2:00 – 3:00 p.m.
📍 Location: Virtual (Zoom)
This session will feature El Futuro, sharing their experience implementing the Collaborative Care Model (CoCM) program with CHWs. It’s a great opportunity to learn from their journey and explore strategies for integrating CHWs into care teams.
Join Zoom Meeting:
https://us02web.zoom.us/j/89721245320?pwd=vZahdMsTNgYvfumrx08NsjzpnFPyKn.1
Meeting ID: 897 2124 5320
Passcode: 758973
Questions Contact Jessica Rodriguez at jessica.rodriguez@mahec.net.
Looking Ahead to 2026
This workgroup series will continue next year, highlighting CHW integration efforts across the state. Stay tuned for more opportunities to connect, share, and learn!
Are you a new or aspiring practice manager, or a provider interested in learning more about practice management? The NC AHEC Practice Management Academy is your gateway to professional growth, networking, and leadership development.
Practice Manager Boot Camp: Leadership Module
Spaces are still available for the Leadership module, starting January 2026!
- Dates: Thursday, January 8, 2026 – Monday, March 9, 2026
- Time: 3:00 PM – 4:00 PM
- Format: Virtual Classes (9 Contact Hours)
- Registration: https://www.southernregionalahec.org/courses-and-events/75763
- Registration closes: January 7, 2026
- Fee: Register by 12/8: $180 | After 12/8: $225
Who Should Attend?
- New and aspiring practice managers
- Providers interested in practice management
- Anyone seeking to enhance leadership and management skills
What You’ll Learn
Week-by-week topics include:
- Braveheart Leadership: Characteristics of inspirational leaders, personal strengths and growth opportunities
- Becoming an Authentic Leader: Impact of gender and implicit bias, authentic leadership styles
- Understanding & Building Your Team: Emotional intelligence (EQ) vs. intelligence quotient (IQ), team dynamics
- Vampires in the Workplace: Identifying and managing toxic staff
- Effective Communication: Professionalism, conflict cycles, and resolution
- Managing Conflict: Power dynamics, critical conversations, crisis communication
- Retaining Effective Employees: Creating a constructive work environment
- Mentoring Physician Leadership: Strategies for orienting provider-leaders, collaboration
- How to Run a Meeting: Structured agendas, facilitation, best practices, and formal meeting structures
Speakers
- GeGe Beall (MS, FACHE, SPHR, SHRM-SCP): Expert in industrial/organizational psychology and HR/organizational development
- Matt Johnson (BA, MA, MBA): Experienced practice administrator, NC Medical Group Management Association board member
- Jane Moran (BA, MLS): Project Specialist, NCAHEC Practice Management Academy, customer service and education expert
- Melissa Overton (BSN, RN, CEO): Award-winning educator, mentor, and CEO of MedicalTraining.me
Why Join the Practice Management Academy Community?
- Free Membership: Access free courses, news, and networking opportunities
- Professional Development: Learn and register for upcoming courses
- Networking: Connect with other practice managers and providers
Many patients with high blood pressure also struggle with limited access to food. A group of North Carolina researchers recently investigated which method of food insecurity interventions worked best to help patients improve their high blood pressure, evaluating food subsidies, delivered food boxes, and lifestyle counseling.
To learn more, check out the ADL’s November 1 Highlighted Resource: Food Insecurity Interventions to Improve Blood Pressure: The Healthy Food First Factorial Randomized Clinical Trial
Guidance for Practice Managers on Navigating the 2026 Network Transition
Practice managers should be fully prepared for the substantial changes coming to the North Carolina State Health Plan (NCSHP) network in 2026. The Plan is facing a $507 million deficit, prompting a thorough evaluation of existing programs and reimbursement models. Sincere gratitude is extended to all organizations that have supported both the Plan and its members during these times. This post outlines what’s changing, why, and what practical steps your practice may need to take.
Clear Pricing Project (CPP) Ending December 2025
The Clear Pricing Project (CPP), launched in 2020, promoted transparent healthcare pricing and aimed to incentivize quality primary and behavioral health care by offering zero copays to members who visited participating providers. While this model brought increased reimbursement rates for many providers, it has not been financially sustainable. As a result, CPP will conclude on December 31, 2025. After that point, providers will no longer receive current elevated reimbursement rates, and members will not have a $0 copay structure for behavioral health services.
Preferred Providers: New Structure in 2026
Effective in 2026, the State Health Plan will roll out the Preferred Provider initiative. The only way for practices to become Preferred Providers will be through affiliation with CCPN (Community Care Physician Network), Aledade, or The Alliance. Practices outside these partnerships will still be considered in-network, but cost shares for members will be different—typically higher than those for Preferred Providers.
Key Action: Review your current affiliations and consider whether joining CCPN, Aledade, or The Alliance is right for your practice. Preferred Providers will grant patients access to lower copays starting in 2026.
Behavioral Health Access Program (BHAP)
To continue supporting behavioral health, the Plan is launching the Behavioral Health Access Program (BHAP) in 2026. This program creates a custom fee schedule for behavioral health providers, specialties, and a specific set of CPT codes:
- 140% of current NC Medicare rates (updated annually, effective May 1) for key codes: psychotherapy, evaluation & management, psychological testing
- ABA services reimbursed at NC Medicaid rates
- TMS codes reimbursed at Aetna Market Fee Schedule (AMFS) rates (same as current CPP)
Action for Behavioral Health Practices: If interested in joining BHAP, visit the Aetna website for enrollment details and next steps.
Working with Aetna: Network Participation & Resources
Aetna will serve as the third-party administrator for the Plan starting January 2026. Practices must be part of Aetna’s Choice POS II network to remain in-network for State Health Plan patients. If not already participating, please visit the Aetna website to begin the enrollment process.
Additional Resources for Practice Managers:
- 2025 NCSHP Network Participation Agreement (Aetna)
- 2025 NCSHP Network Rate Schedule (Aetna)
- 2025 NCSHP Network Professional Fee Schedule (Aetna)
- Aetna Provider Website
- Signup for Aetna emails
- OfficeLinks Updates Newsletters
- Aetna Provider State Health Plan site
- Aetna Resources
For contract, reimbursement, or benefits questions, contact Aetna Provider Line at 888-632-3862. For clinical or precertification information, refer to Aetna’s clinical information and prior review resources. Email NorthCarolinaNetwork@aetna.com for network queries, or SHPProviderNetwork@nctreasurer.com for State Health Plan questions.
What Practice Managers Should Do Now
- Evaluate providers’ current affiliations and consider joining CCPN, Aledade, or The Alliance for Preferred Provider status.
- For behavioral health, review the BHAP program and assess if it matches the needs of your practice.
- Ensure participation in Aetna’s Choice POS II network before January 2026 to maintain in-network status.
- Stay updated on policy changes, copay and reimbursement structures, and communicate these changes to your team and patients.
