--- title: Practice Support Services | practice management description: practice management | 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. --- [![nwahec.png](https://go.northwestahec.wakehealth.edu/hs-fs/hubfs/WFUSM_NWAHEC%20Cobranding%20Logo_H_RGB.png?width=2025&height=300&name=WFUSM_NWAHEC%20Cobranding%20Logo_H_RGB.png "nwahec.png")](https://go.northwestahec.wakehealth.edu/) - [Home](https://go.northwestahec.wakehealth.edu) - [What's New at NWAHEC Blog](https://go.northwestahec.wakehealth.edu/blog) - [NWAHEC Staff](https://go.northwestahec.wakehealth.edu/staff) - [Practice Support Updates](https://go.northwestahec.wakehealth.edu/practicesupport) # Practice Support Update Blog ## [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) ## [🎧 2025 Wrapped: Your Year in Practice Transformation](https://go.northwestahec.wakehealth.edu/practicesupport/2025-wrapped) Dec 17, 2025, 8:23:38 AM / by [Practice Support Team](https://go.northwestahec.wakehealth.edu/practicesupport/author/practice-support-team) posted in [Medicaid Managed Care](https://go.northwestahec.wakehealth.edu/practicesupport/topic/medicaid-managed-care), [Quality Improvement](https://go.northwestahec.wakehealth.edu/practicesupport/topic/quality-improvement), [practice management](https://go.northwestahec.wakehealth.edu/practicesupport/topic/practice-management) [0 Comments](https://go.northwestahec.wakehealth.edu/practicesupport/2025-wrapped#comments-listing) ### 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](https://go.northwestahec.wakehealth.edu/blog/twincitypeds)**🌟 - *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** ![🤝](https://fonts.gstatic.com/s/e/notoemoji/16.0/1f91d/32.png) - *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](https://northwestahec.wakehealth.edu/t3/courses-and-events/75892/falls-screening-risk-assessment-and-care-planning-for-older-adult-patients-in-the-community) 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 Farewell Tour: Clear Pricing Project (CPP)** 👋 - *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](mailto:practicesupport@wakehealth.edu).* [Read More](https://go.northwestahec.wakehealth.edu/practicesupport/2025-wrapped) ## [Join Us for the NC AHEC Practice Management Academy!](https://go.northwestahec.wakehealth.edu/practicesupport/join-us-for-the-nc-ahec-practice-manager-academy) Dec 3, 2025, 9:29:59 AM / by [Practice Support Team](https://go.northwestahec.wakehealth.edu/practicesupport/author/practice-support-team) posted in [practice support](https://go.northwestahec.wakehealth.edu/practicesupport/topic/practice-support), [practice management](https://go.northwestahec.wakehealth.edu/practicesupport/topic/practice-management) [0 Comments](https://go.northwestahec.wakehealth.edu/practicesupport/join-us-for-the-nc-ahec-practice-manager-academy#comments-listing) Are you a new or aspiring practice manager, or a provider interested in learning more about practice management? The [**NC AHEC Practice Management Academy**](https://www.southernregionalahec.org/courses-and-events/75763) 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 [![Practice Management Academy](https://no-cache.hubspot.com/cta/default/7413846/260de5a7-1a1e-4bf6-a388-bc1f3e403b99.png)](https://cta-redirect.hubspot.com/cta/redirect/7413846/260de5a7-1a1e-4bf6-a388-bc1f3e403b99) [Read More](https://go.northwestahec.wakehealth.edu/practicesupport/join-us-for-the-nc-ahec-practice-manager-academy) ## [Now Available: 2026 MIPS Payment Adjustment Information](https://go.northwestahec.wakehealth.edu/practicesupport/now-available-2026-mips-payment-adjustment-information) Oct 15, 2025, 4:39:19 PM / by [Practice Support Team](https://go.northwestahec.wakehealth.edu/practicesupport/author/practice-support-team) posted in [quality payment program](https://go.northwestahec.wakehealth.edu/practicesupport/topic/quality-payment-program), [practice management](https://go.northwestahec.wakehealth.edu/practicesupport/topic/practice-management), [CMS](https://go.northwestahec.wakehealth.edu/practicesupport/topic/cms) [0 Comments](https://go.northwestahec.wakehealth.edu/practicesupport/now-available-2026-mips-payment-adjustment-information#comments-listing) *![Payment Concept. Button on Modern Computer Keyboard with Word Partners on It.](https://go.northwestahec.wakehealth.edu/hs-fs/hubfs/Payment%20%20Concept.%20Button%20on%20Modern%20Computer%20Keyboard%20with%20Word%20Partners%20on%20It..jpeg?width=300&height=225&name=Payment%20%20Concept.%20Button%20on%20Modern%20Computer%20Keyboard%20with%20Word%20Partners%20on%20It..jpeg)* *From the CMS QPP Updates Newsletter:* [Read More](https://go.northwestahec.wakehealth.edu/practicesupport/now-available-2026-mips-payment-adjustment-information) ## [NC Medicaid Rate Reductions - Effective October 1, 2025](https://go.northwestahec.wakehealth.edu/practicesupport/nc-medicaid-rate-reductions-effective-october-1-2025) Oct 1, 2025, 3:00:00 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), [Medicaid Managed Care](https://go.northwestahec.wakehealth.edu/practicesupport/topic/medicaid-managed-care), [coding](https://go.northwestahec.wakehealth.edu/practicesupport/topic/coding), [practice management](https://go.northwestahec.wakehealth.edu/practicesupport/topic/practice-management) [0 Comments](https://go.northwestahec.wakehealth.edu/practicesupport/nc-medicaid-rate-reductions-effective-october-1-2025#comments-listing) ![Medicaid](https://go.northwestahec.wakehealth.edu/hs-fs/hubfs/Practice%20Support%20Files/Medicaid.jpeg?width=300&height=157&name=Medicaid.jpeg) North Carolina Medicaid provider [reimbursement rate reductions](https://medicaid.ncdhhs.gov/blog/2025/09/25/nc-medicaid-rate-reductions-effective-oct-1-2025) go into effect October 1, 2025. The reduction percentages vary from 3%,  8% or 10% and apply to procedure codes. NC Medicaid plans to publish detailed updated fee schedules to the [NC Medicaid Covered Codes and Fee Schedules Portal](https://ncdhhs.servicenowservices.com/fee_schedules). You are advised to check back frequently for these updated documents.  [Read More](https://go.northwestahec.wakehealth.edu/practicesupport/nc-medicaid-rate-reductions-effective-october-1-2025) ## [Vaya Health Network Provider Communication](https://go.northwestahec.wakehealth.edu/practicesupport/vaya-health-network-provider-communication) Sep 29, 2025, 2:30:00 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), [Medicaid Managed Care](https://go.northwestahec.wakehealth.edu/practicesupport/topic/medicaid-managed-care), [Primary Care](https://go.northwestahec.wakehealth.edu/practicesupport/topic/primary-care), [behavioral health](https://go.northwestahec.wakehealth.edu/practicesupport/topic/behavioral-health), [practice management](https://go.northwestahec.wakehealth.edu/practicesupport/topic/practice-management) [0 Comments](https://go.northwestahec.wakehealth.edu/practicesupport/vaya-health-network-provider-communication#comments-listing) ![parkway.autumn.gg](https://go.northwestahec.wakehealth.edu/hs-fs/hubfs/parkway.autumn.gg.jpg?width=300&height=200&name=parkway.autumn.gg.jpg) North Carolina Division of Health Benefits officially notified Vaya Health of upcoming changes to the NC Medicaid fee schedule rates effective October 1, 2025. The new detailed fee schedule changes have not yet been provided. Vaya Health notified network providers in their [recent bulletin](https://go.northwestahec.wakehealth.edu/hubfs/PCB-09-26-25-Issue-16.pdf) that it will update their systems to implement the fee schedule changes no earlier than November 1, 2025.  If there is no legislative agreement by October 31, Vaya will implement the rate cuts on November 1, retroactive to the effective date of October 1.  On that date they plan to update their systems to pay at the newly published rates, and will take steps to recoup the difference in reimbursement for services provided back to October 1. Vaya indicated they will issue [more detailed communications soon](https://go.northwestahec.wakehealth.edu/hubfs/PCB-09-26-25-Issue-16.pdf), and provided links to email them with questions as well as a link to join the Vaya Provider Touchpoint webinar on October 3rd. *Source: [https://providers.vayahealth.com/bulletins/](https://providers.vayahealth.com/bulletins/)* [Read More](https://go.northwestahec.wakehealth.edu/practicesupport/vaya-health-network-provider-communication) ## [Fifth Annual Virtual Statewide Quality Forum](https://go.northwestahec.wakehealth.edu/practicesupport/fifth-annual-virtual-statewide-quality-forum-1) Sep 23, 2025, 11:16:13 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), [Quality Improvement](https://go.northwestahec.wakehealth.edu/practicesupport/topic/quality-improvement), [practice management](https://go.northwestahec.wakehealth.edu/practicesupport/topic/practice-management) [0 Comments](https://go.northwestahec.wakehealth.edu/practicesupport/fifth-annual-virtual-statewide-quality-forum-1#comments-listing) ![autumn.path.gg](https://go.northwestahec.wakehealth.edu/hs-fs/hubfs/autumn.path.gg.png?width=300&height=200&name=autumn.path.gg.png) NC Medicaid, in collaboration with the five NC Medicaid Managed Care Standard Plans, hosts the...         Fifth Annual Virtual Statewide Quality Forum Wednesday, October 8 from noon-1:30 p.m. Topics will include: - Administrative Simplification Workgroup Updates - Early Intervention and EPSDT: Proven Strategies for Success – Feedback from Providers  and Standard Plans - Key Updates from NC Medicaid The forum is designed for providers, practice managers, and quality managers to engage in  focused discussion about how to successfully apply Medicaid Managed Care quality initiatives to  generate positive outcomes. Please [register to participate](https://forms.office.com/pages/responsepage.aspx?id=3IF2etC5mkSFw-zCbNftGf197VAvGTxGk-NJLI4LpQpUQkhDVklXUUtSUjg0SEpMR0wzNzRXOUlRMi4u&route=shorturl) in this valuable and informative forum that will offer practical  applications to enhance and improve your services to NC Medicaid members. [Read More](https://go.northwestahec.wakehealth.edu/practicesupport/fifth-annual-virtual-statewide-quality-forum-1) ## [Payers in NC Implement Downcoding Claims and Code Review Programs](https://go.northwestahec.wakehealth.edu/practicesupport/payers-in-nc-implement-downcoding-claims-and-code-review-programs) Sep 2, 2025, 9:30:00 AM / by [Practice Support Team](https://go.northwestahec.wakehealth.edu/practicesupport/author/practice-support-team) posted in [coding](https://go.northwestahec.wakehealth.edu/practicesupport/topic/coding), [practice management](https://go.northwestahec.wakehealth.edu/practicesupport/topic/practice-management), [claims](https://go.northwestahec.wakehealth.edu/practicesupport/topic/claims), [insurance](https://go.northwestahec.wakehealth.edu/practicesupport/topic/insurance) [0 Comments](https://go.northwestahec.wakehealth.edu/practicesupport/payers-in-nc-implement-downcoding-claims-and-code-review-programs#comments-listing) ![Strong Connection between Chrome Carabiner and two Red Ropes Symbolising the Insurance. Selective Focus.-1](https://go.northwestahec.wakehealth.edu/hs-fs/hubfs/Strong%20Connection%20between%20Chrome%20Carabiner%20and%20two%20Red%20Ropes%20Symbolising%20the%20Insurance.%20Selective%20Focus.-1.jpeg?width=300&height=180&name=Strong%20Connection%20between%20Chrome%20Carabiner%20and%20two%20Red%20Ropes%20Symbolising%20the%20Insurance.%20Selective%20Focus.-1.jpeg) Several health insurance companies in North Carolina have recently implemented programs to review claims and codes that results in the down coding of Level 4 and Level 5 Evaluation and Management (E/M) claims. According to the [North Carolina Medical Society](https://ncmedsoc.org/latest-update-on-nc-health-insurance-payers-implementing-downcoding-claims-review-programs/), Aetna's process does not target all Level 4 and 5 codes, nor does it include all providers within the state. However, there remains confusion about why the insurer has implemented this program. [Cigna's approach is broader](https://providernewsroom.com/cigna-healthcare/new-reimbursement-policy-for-professional-evaluation-and-management-services-claims-effective-october-1-2025/) and applies to all physicians and to six E/M codes: 99204-99205 (new patient), 99214-99215 (established patient), and 99244-99245 (consult for new & established patients). Cigna will implement this review nationally on October 1, 2025.   Along with the North Carolina Medical Society, many [professional societies](https://www.apma.org/about-apma/news/news-releases/2025/apma-takes-action-engaging-aetna-on-downcoding-policy/) across the country are also [alerting their members](https://www.texmed.org/TexasMedicineDetail.aspx?id=66499) to this issue.  It is critical to follow the appropriate appeals process for any claims you believe to be inappropriately down coded!  [Read More](https://go.northwestahec.wakehealth.edu/practicesupport/payers-in-nc-implement-downcoding-claims-and-code-review-programs) ## [Medicaid Managed Care Virtual Office Hours](https://go.northwestahec.wakehealth.edu/practicesupport/medicaid-managed-care-virtual-office-hours-1) Aug 19, 2025, 9:45:00 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), [Primary Care](https://go.northwestahec.wakehealth.edu/practicesupport/topic/primary-care), [practice management](https://go.northwestahec.wakehealth.edu/practicesupport/topic/practice-management) [0 Comments](https://go.northwestahec.wakehealth.edu/practicesupport/medicaid-managed-care-virtual-office-hours-1#comments-listing) ![NC AHEC and DHS Logos\_WHITE on BLUE-01](https://go.northwestahec.wakehealth.edu/hs-fs/hubfs/NC%20AHEC%20and%20DHS%20Logos_WHITE%20on%20BLUE-01.png?width=563&height=247&name=NC%20AHEC%20and%20DHS%20Logos_WHITE%20on%20BLUE-01.png)WEBINAR Virtual Office Hours STAY IN THE KNOW: Key NC Medicaid Updates for Provider Office Staff Thursday, September 4 | noon - 1 p.m. Please join us on Thursday, September 4 from noon-1 p.m. for an informative Virtual Office Hours webinar to get updates and hear the latest statuses on hot program topics that are impactful to the provider community! Get the insights and resources you need to navigate upcoming developments with NC Medicaid.  Webinar topics will include: - EPSDT: Pay and Chase - Carolina ACCESS Enrollment Refresher - Maintaining Eligibility Program - Children and Family Specialty Program – Provider Contracting - Credentialing Committee Updates - Avoid Common Enrollment Application Issues Cont’d - Key Resource: NC Medicaid Provider Ombudsman **Register by clicking the blue button below. We look forward to connecting with you!** [![Register for theMedicaid Managed Care Virtual Office Hours](https://no-cache.hubspot.com/cta/default/7413846/b02013d1-013d-454b-ad65-ff496cf37248.png)](https://cta-redirect.hubspot.com/cta/redirect/7413846/b02013d1-013d-454b-ad65-ff496cf37248) [Read More](https://go.northwestahec.wakehealth.edu/practicesupport/medicaid-managed-care-virtual-office-hours-1) ## [Aetna Health Plan: What Should You Be Doing?](https://go.northwestahec.wakehealth.edu/practicesupport/aetna-health-plan-what-should-you-be-doing) Jul 31, 2025, 7:30:00 AM / by [Practice Support Team](https://go.northwestahec.wakehealth.edu/practicesupport/author/practice-support-team) posted in [practice management](https://go.northwestahec.wakehealth.edu/practicesupport/topic/practice-management), [payer contracting](https://go.northwestahec.wakehealth.edu/practicesupport/topic/payer-contracting) [0 Comments](https://go.northwestahec.wakehealth.edu/practicesupport/aetna-health-plan-what-should-you-be-doing#comments-listing) At this time, there’s been no indication that the Clear Pricing Project (CPP) will be extended or replaced for primary care. The only new program announced so far is the Behavioral Health Access Program (BHAP), which does not apply to primary care providers. That said, here are a few proactive steps you can take: - **Review your current contracts with Aetna** to understand how your reimbursement rates may change once CPP ends. - **Consider renegotiating** your contract. Many practices are already doing this to secure more sustainable terms. - **Ensure you’re part of Aetna’s Choice POS II network**, which the NC State Health Plan will use exclusively starting January 1, 2025. 👉 [Join the Aetna Network](https://www.aetna.com/health-care-professionals/join-the-aetna-network.html) 👉[Behavioral Health Access Program(BHAP)](https://www.aetna.com/health-care-professionals/north-carolina-state-health-plan/nc-behavioral-health-access-program.html?cid=eml_prov_11388) [Read More](https://go.northwestahec.wakehealth.edu/practicesupport/aetna-health-plan-what-should-you-be-doing) [All posts](https://go.northwestahec.wakehealth.edu/practicesupport/all) [Next](https://go.northwestahec.wakehealth.edu/practicesupport/tag/practice-management/page/2) This is a search field with an auto-suggest feature attached. - There are no suggestions because the search field is empty. ### Practice Support Services Health care practices in North Carolina face many challenges. Our team of quality improvement coaches (QICs) have skills and expertise to support you in your transformation efforts. To learn more about [Practice Support Click Here](https://school.wakehealth.edu/Education-and-Training/Continuing-Professional-Education/Northwest-AHEC/Practice-Support-Services) Apply for practice support services - **[submit an email inquiry](mailto:practicesupport@ncahec.net)** ### Subscribe to Blog Updates ### Additional Resources: [![Tip Sheets](https://no-cache.hubspot.com/cta/default/7413846/3250b519-7b04-46c8-8a05-c761461c996f.png)](https://cta-redirect.hubspot.com/cta/redirect/7413846/3250b519-7b04-46c8-8a05-c761461c996f) [![Lib Guides](https://no-cache.hubspot.com/cta/default/7413846/a0754bf6-f1f0-475d-bbf4-17bea63ef9c1.png)](https://cta-redirect.hubspot.com/cta/redirect/7413846/a0754bf6-f1f0-475d-bbf4-17bea63ef9c1) [![Interactive Resource Guides](https://no-cache.hubspot.com/cta/default/7413846/84d3d6ee-36ec-4b91-9ec2-410c87e1fefc.png)](https://cta-redirect.hubspot.com/cta/redirect/7413846/84d3d6ee-36ec-4b91-9ec2-410c87e1fefc) [![Digital Library](https://no-cache.hubspot.com/cta/default/7413846/36614b2e-461f-444c-b2a9-08ee8a5f03c1.png)](https://cta-redirect.hubspot.com/cta/redirect/7413846/36614b2e-461f-444c-b2a9-08ee8a5f03c1) [![Join email list](https://no-cache.hubspot.com/cta/default/7413846/d2ffefd9-3e10-48ff-95be-d9cd6d269bd2.png)](https://cta-redirect.hubspot.com/cta/redirect/7413846/d2ffefd9-3e10-48ff-95be-d9cd6d269bd2) Connect With Us: ### Posts by Topic - 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Check Out These Recent Posts # 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. 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