--- title: Practice Support Services | Billing description: Billing | 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 ## [Putting Strategy into Practice: Implementing a Hospital Readmissions Reduction Approach](https://go.northwestahec.wakehealth.edu/practicesupport/putting-strategy-into-practice-implementing-a-hospital-readmissions-reduction-approach) Jun 23, 2026, 9:00:04 AM / by [Chris Jones, DrPH](https://go.northwestahec.wakehealth.edu/practicesupport/author/chris-jones) posted in [Medicaid Managed Care](https://go.northwestahec.wakehealth.edu/practicesupport/topic/medicaid-managed-care), [Billing](https://go.northwestahec.wakehealth.edu/practicesupport/topic/billing) [0 Comments](https://go.northwestahec.wakehealth.edu/practicesupport/putting-strategy-into-practice-implementing-a-hospital-readmissions-reduction-approach#comments-listing) ![Examination of financial condition Stethoscope on pile of U.S. twenty-dollar bills isolated on white background](https://go.northwestahec.wakehealth.edu/hs-fs/hubfs/Examination%20of%20financial%20condition%20Stethoscope%20on%20pile%20of%20U.S.%20twenty-dollar%20bills%20isolated%20on%20white%20background.jpeg?width=386&height=256&name=Examination%20of%20financial%20condition%20Stethoscope%20on%20pile%20of%20U.S.%20twenty-dollar%20bills%20isolated%20on%20white%20background.jpeg)Hospital readmissions remain a persistent challenge for health systems and primary care practices alike. While the policy drivers behind readmission reduction are well known, translating those expectations into day-to-day clinical workflows is where the real work begins. For many practices, implementation is less about a single intervention and more about building a coordinated, sustainable approach across the care continuum. [Read More](https://go.northwestahec.wakehealth.edu/practicesupport/putting-strategy-into-practice-implementing-a-hospital-readmissions-reduction-approach) ## [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) [0 Comments](https://go.northwestahec.wakehealth.edu/practicesupport/new-upfront-claim-rejections-begin-april-1-2026-what-providers-need-to-know#comments-listing) 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) ## [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) ## [Healthcare Mastery Series: Professionalism, Collections, and E/M Coding (FREE)](https://go.northwestahec.wakehealth.edu/practicesupport/healthcare-mastery-series-professionalism-collections-and-e/m-coding-free) Jun 4, 2025, 8:30:00 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), [practice management](https://go.northwestahec.wakehealth.edu/practicesupport/topic/practice-management) [0 Comments](https://go.northwestahec.wakehealth.edu/practicesupport/healthcare-mastery-series-professionalism-collections-and-e/m-coding-free#comments-listing) ![Mid adult female receptionist receiving card from patient in dentist clinic](https://go.northwestahec.wakehealth.edu/hs-fs/hubfs/Mid%20adult%20female%20receptionist%20receiving%20card%20from%20patient%20in%20dentist%20clinic.jpeg?width=300&height=200&name=Mid%20adult%20female%20receptionist%20receiving%20card%20from%20patient%20in%20dentist%20clinic.jpeg) We’re excited to share a new opportunity from SEAHEC: the **Healthcare Mastery Series**, a free three-part learning experience designed to strengthen your front office operations and clinical documentation practices. This series offers practical tools and expert-led insights on: - **[Front Office Professional](https://www.seahec.net/courses-and-events/75789/the-front-office-professional)**– June 11 at 12 PM - **[Point of Service Collections](https://www.seahec.net/courses-and-events/75790/point-of-service-collections)**– June 18 at 12 PM - **[Coding and Documentation: Revised Guidelines for Office and Hospital Evaluation and Management Coding](https://www.seahec.net/courses-and-events/75791/coding-and-documentation-revised-guidelines-for-office-and-hospital-evaluation-and-management-coding)**– July 16 at 12 PM Each session is a FREE, one hour and tailored to help your team enhance patient engagement, streamline workflows, and stay current with evolving standards in healthcare delivery.  You can register for any or all of the webinars. For more details, see the brochure [HERE.](https://go.northwestahec.wakehealth.edu/hubfs/Healthcare_Mastery_Series.6.2.25.pdf)  [Read More](https://go.northwestahec.wakehealth.edu/practicesupport/healthcare-mastery-series-professionalism-collections-and-e/m-coding-free) ## [RHCs and FQHCs: May need to re-submit claims](https://go.northwestahec.wakehealth.edu/practicesupport/rhcs-and-fqhcs-may-need-to-re-submit-claims) Jan 17, 2025, 2:30:00 PM / 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), [rural health centers](https://go.northwestahec.wakehealth.edu/practicesupport/topic/rural-health-centers), [claims](https://go.northwestahec.wakehealth.edu/practicesupport/topic/claims), [FQHC](https://go.northwestahec.wakehealth.edu/practicesupport/topic/fqhc) [0 Comments](https://go.northwestahec.wakehealth.edu/practicesupport/rhcs-and-fqhcs-may-need-to-re-submit-claims#comments-listing) ![photo-1682706841289-9d7ddf5eb999](https://go.northwestahec.wakehealth.edu/hubfs/photo-1682706841289-9d7ddf5eb999.avif)Starting October 1, 2024, the Centers for Medicare and Medicaid Services incorrectly returned certain Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) claims with reason code W7072: - Type of bill: 017X (RHC) and 077X (FQHC) - HCPCS code 93010 (electrocardiogram, EKG or ECG) RHCs and FQHCs should resubmit these claims that were returned in error. [Read More](https://go.northwestahec.wakehealth.edu/practicesupport/rhcs-and-fqhcs-may-need-to-re-submit-claims) ## [Tailored Plan Touchpoints, Alerts and Support](https://go.northwestahec.wakehealth.edu/practicesupport/tailored-plan-touchpoints-alerts-and-support) Jun 4, 2024, 7:47:00 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), [Primary Care](https://go.northwestahec.wakehealth.edu/practicesupport/topic/primary-care), [practice management](https://go.northwestahec.wakehealth.edu/practicesupport/topic/practice-management), [Tailored Plans](https://go.northwestahec.wakehealth.edu/practicesupport/topic/tailored-plans) [0 Comments](https://go.northwestahec.wakehealth.edu/practicesupport/tailored-plan-touchpoints-alerts-and-support#comments-listing) ![gull.sunset.GG](https://go.northwestahec.wakehealth.edu/hs-fs/hubfs/gull.sunset.GG.jpg?width=300&height=192&name=gull.sunset.GG.jpg) Tailored Plans are set to launch on July 1, 2024. As a provider of physical health services, you and your teams need to know how and where to submit claims for payment of services rendered.  [Read More](https://go.northwestahec.wakehealth.edu/practicesupport/tailored-plan-touchpoints-alerts-and-support) ## [G2211: Have You Heard?](https://go.northwestahec.wakehealth.edu/practicesupport/g2211-have-you-heard) Jan 15, 2024, 9:59:00 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), [Primary Care](https://go.northwestahec.wakehealth.edu/practicesupport/topic/primary-care), [medicare](https://go.northwestahec.wakehealth.edu/practicesupport/topic/medicare), [practice management](https://go.northwestahec.wakehealth.edu/practicesupport/topic/practice-management) [0 Comments](https://go.northwestahec.wakehealth.edu/practicesupport/g2211-have-you-heard#comments-listing) ![3d stainless human social network and leadership as concept](https://go.northwestahec.wakehealth.edu/hs-fs/hubfs/3d%20stainless%20human%20social%20network%20and%20leadership%20as%20concept.jpeg?width=300&height=300&name=3d%20stainless%20human%20social%20network%20and%20leadership%20as%20concept.jpeg) Did you know? The typical primary care physician caring for Medicare patients must coordinate care with 229 other physicians working in 117 practices?   The 2024 Final Rule from CMS (Center for Medicare and Medicaid Services) established a new code to ensure Primary Care Providers receive additional payment for the high-value visits they provide. [Read More](https://go.northwestahec.wakehealth.edu/practicesupport/g2211-have-you-heard) ## [Provider Relief Fund Post-Payment Reporting and Audits](https://go.northwestahec.wakehealth.edu/practicesupport/providerrelief) Sep 9, 2021, 8:00:00 AM / by [Practice Support Team](https://go.northwestahec.wakehealth.edu/practicesupport/author/practice-support-team) posted in [COVID-19](https://go.northwestahec.wakehealth.edu/practicesupport/topic/covid-19), [Billing](https://go.northwestahec.wakehealth.edu/practicesupport/topic/billing) [0 Comments](https://go.northwestahec.wakehealth.edu/practicesupport/providerrelief#comments-listing) Provider Relief Fund (PRF) recipients who received one or more payments exceeding, in the aggregate, $10,000 during a Payment Received Period are required to report as part of the post-payment reporting process. The reporting portal is now open. If you received payments from the fund between April and June 2020 you are required to report prior to September 30th, 2021.  [Read More](https://go.northwestahec.wakehealth.edu/practicesupport/providerrelief) ## [Strategies for SUDs in the Primary Care Setting Webinar Series](https://go.northwestahec.wakehealth.edu/practicesupport/strategies-for-suds-in-the-primary-care-setting-webinar-series) Sep 1, 2021, 5:45:00 PM / 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) [0 Comments](https://go.northwestahec.wakehealth.edu/practicesupport/strategies-for-suds-in-the-primary-care-setting-webinar-series#comments-listing) In an effort to improve healthcare quality and reduce costs, many states and healthcare plans are adoption Value-based payments. These financial levers are being used to encourage AUD/SUD treatment in primary care settings. This program is designed to give you an understanding of how to apply harm reduction strategies for AUD/SUD in primary care setting, including quick interventions and next steps if patients are deemed in need of immediate intervention-crisis. [Read More](https://go.northwestahec.wakehealth.edu/practicesupport/strategies-for-suds-in-the-primary-care-setting-webinar-series) ## [​Medicaid Managed Care: Flexibilities Extended for Out of Network Providers  ​](https://go.northwestahec.wakehealth.edu/practicesupport/medicaid-managed-care-flexibilities-extended-for-out-of-network-providers) Aug 26, 2021, 8:00:00 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), [Billing](https://go.northwestahec.wakehealth.edu/practicesupport/topic/billing) [0 Comments](https://go.northwestahec.wakehealth.edu/practicesupport/medicaid-managed-care-flexibilities-extended-for-out-of-network-providers#comments-listing) In an effort to ensure optimal access to care for Medicaid beneficiaries, to support providers during the recent COVID-19 surge, and to alleviate potential provider payment concerns, DHHS and the prepaid health plans (PHPs) have agreed to extend the policy for out of network flexibilities to **providers who have not yet contacted with a PHP through Nov. 30, 2021**. These flexibilities were originally expected to sunset on Aug. 30, 2021.    [Read More](https://go.northwestahec.wakehealth.edu/practicesupport/medicaid-managed-care-flexibilities-extended-for-out-of-network-providers) [All posts](https://go.northwestahec.wakehealth.edu/practicesupport/all) [Next](https://go.northwestahec.wakehealth.edu/practicesupport/tag/billing/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. 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