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 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 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 Medicaid provider reimbursement rate reductions 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. You are advised to check back frequently for these updated documents. 

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 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, 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/

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 in this valuable and informative forum that will offer practical 
applications to enhance and improve your services to NC Medicaid members.

WEBINAR

Medicaid Managed Care

NC Medicaid Quality Measurement & Benchmarking

Tuesday, September16|noon-1p.m.

Please join us on September 16 at noon for a webinar on NC Medicaid Quality Measurement and Benchmarking which will include the following:

• Introduction to NC Medicaid's quality measurement strategy and the Advanced Medical Home (AMH) measure set.
  
• Summary of annual update process for the AMH measure set & review of changes to MY2026 AMH set.
  
• Update to NC Medicaid's benchmarking approach for quality measures. We will walk through the Gap-to-Goal and Beat the Trend methodologies and how they apply to the AMH measure set.

Register by clicking on the blue button below.

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!

From NC Medicaid:

Children & Families Specialty Plan

The Primary Care Provider (PCP) contracting deadline for Beneficiary Choice Period is September 1, 2025.

The Children and Families Specialty Plan (CFSP) is a single, statewide NC Medicaid Managed Care health plan designed to support children, youth and young adults currently and formerly served by the child welfare system. Sept. 1, 2025, is the last day for PCPs to have fully executed contracts with the CFSP for inclusion at the start of the Beneficiary Choice Period.  Go Live Date is 12/1/25. 

Providers who wish to participate in CFSP should contact Health Blue Care Together to discuss the contracting process and requirements.

For inquiries, please use the following contacts:

Email:

• Contracting Inquiries: NC_Contracting@healthybluenc.com
• General Questions and Comments: NC_Provider@healthybluenc.com

Phone:

1-844-594-5072

For more details on the CFSP, including eligibility, covered services and updates, please visit our Children and Families Specialty Plan website. You can also find more information by reviewing the What Providers Need to Know fact sheet.

Date: August 26, 2025

Time: 12:00 - 1 p.m.

The Statewide Health Information Exchange Act was passed in 2015 by the North Carolina General Assembly.  This legislation paved the way for a statewide health information exchange (HIE), now known as NC HealthConnex.

NC HealthConnex is a valuable tool to support care improvement efforts.  In the context of value-based care, providers need access to timely, accurate clinical data to track outcomes and coordinate care effectively.  By its very definition, value-based care requires visibility into a patient's full journey across the care continuum.

Real-time, reliable clinical data is a critical tool for delivering appropriate care and closing information gaps. NC HealthConnex supports this by offering services that allow providers to:

• Query patients,

• Receive Admission, Discharge and Transfer notifications, and

• Send encrypted messages to other providers involved in a patient’s care.

NC Medicaid’s transition to NC Medicaid Managed Care, the launch of Tailored Care Management, and Medicaid Expansion make NC HealthConnex services an increasingly valuable follow-up tool for providers. The North Carolina Health Information Exchange Authority (NC HIEA), the state  agency that oversees NC HealthConnex, and NC Medicaid have built a strong partnership, collaborating through NC Medicaid Managed Care launch and the COVID-19 pandemic. Today, they are working together on a series of use cases that leverage NC HealthConnex to support NC Medicaid’s quality and population health goals.

In this session, speakers will explain how NC HealthConnex works, review available services, and provide a live demonstration of the NC HealthConnex Clinical Portal. They will also highlight current innovations stemming from the collaboration between NC Medicaid and the NC HIEA. Attendees will leave with an understanding of how NC HealthConnex and its services can serve as valuable tools to support high-quality, coordinated patient care.

MEDICAID MANAGED CARE

Disaster Preparedness for Members with Chronic Conditions

August 19 | NOON - 1 p.m.

Please join us for the last webinar in this series focused on disaster preparedness for members with chronic conditions.  This webinar will cover the following:

• Long term recovery considerations
• Behavioral Health impacts
• Finding resources
• Crisis Services
• Hope 4 NC
• Understanding Resilience
• Building Resilience

Register by clicking the button below. We look forward to connecting with you!

Save the Date!

Fifth Annual Virtual Statewide Quality Forum

October 8, 2025 | noon - 1 p.m.

The North Carolina Department of Health and Human Services Division of Health Benefits and North Carolina AHEC, in conjunction with the five Medicaid managed care standard plans, will host the Fifth Annual Virtual Statewide Quality Forum on October 8 from noon-1 p.m. Topics will include:

• Simplification Updates
• Key Developments on NC Division of Health Benefits
• Key Developments on 2026 Advanced Medical Home Measures and Benchmarking Approach
• Key Developments on NC HealthConnex Updates
• Screen Early, Optimize Health: Proven Strategies for Success

The forum is designed to help providers, practice managers, and quality managers succeed with Medicaid Managed Care quality initiatives. Look for additional details, including how to register, soon.

We hope you can join us!