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

What Practice Staff and Managers Need to Know about Measles: a tip sheet from NC AHEC’s Practice Support service line

What Parents Need to Know: patient-focused information from the American Academy of Pediatrics

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 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 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 page.

FDA CLIA Database: For information regarding specific test categorizations and waived analytes, use the FDA CLIA Database. 

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.

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)

• Streamline billing and paperwork processes.
• Enhance direct provider support.
• Improve the overall efficiency of Tailored Plan operations.

1. Review the New Contract: Trillium is asking providers to sign a new Procurement Contract for Provision of Services. This can be signed quickly via DocuSign.
2. Watch for Outreach from Andros: Trillium has partnered with Andros, 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 video, which provides a walkthrough of these updates.

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]

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]

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]

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]

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]

In outbreak areas

Providers may consider early second doses or early infant vaccination (6–12 months), depending on risk. [Measles Patient FAQ | 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]

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]

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]

If measles is suspected, have families call before arrival so your clinic can prepare isolation precautions. [Measles Patient FAQ | 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]

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

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.

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 or calling 1-877-331-7154, option 1.

For CCH providers

 The public website will remain 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

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

Provider Services Contact:
1‑833‑552‑3876
NetworkRelations@CCH-Network.com

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.

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

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

NC Medicaid has announced important updates to coverage for Psychiatric Collaborative Care Management (CoCM) services, effective December 31, 2025. This change impacts both NC Medicaid Direct and NC Medicaid Managed Care programs.

Key Update: End-Dating of HCPCS Code G0512

The Healthcare Common Procedure Coding System (HCPCS) code G0512 will be end-dated on Dec. 31, 2025. This means Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) must transition to reporting CoCM services using individual CPT and HCPCS codes that previously comprised G0512.

Per Centers for Medicare & Medicaid Services (CMS) guidance, the following codes should now be used:

• 99492 – Initial psychiatric collaborative care management, first 70 minutes in the first calendar month.
• 99493 – Subsequent psychiatric collaborative care management, first 60 minutes in a subsequent month of behavioral health care manager activities.
• G2214 – Initial or subsequent psychiatric collaborative care management, first 30 minutes in a month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified healthcare professional.
• 99494 – Initial or subsequent psychiatric collaborative care management, each additional 30 minutes in a calendar month (up to four 30-minute sessions allowed per month).

Why This Matters

This update ensures alignment with CMS requirements and supports accurate reporting for CoCM services. Providers should review their billing practices and update systems to reflect these changes before the effective date.

Background

This bulletin serves as an update to the Sept. 17, 2025 bulletin on Psychiatric Collaborative Care Management coverage. NC Medicaid continues to emphasize integrated behavioral health care and collaborative models to improve patient outcomes.

Action Steps for Providers

• Discontinue use of G0512 after Dec. 31, 2025.
• Begin reporting CoCM services using codes 99492, 99493, 99494, and G2214.
• Ensure billing staff and systems are updated to comply with these changes.

For more details, visit the official NC Medicaid blog:
https://medicaid.ncdhhs.gov/blog/2025/12/30/updated-coverage-psychiatric-collaborative-care-management-december-30-2025

We’re excited to share a major development for rural health in North Carolina. Last week, the Centers for Medicare & Medicaid Services (CMS) approved North Carolina’s application for the Rural Health Transformation Program (RHTP)—a milestone that brings over $213 million in the first year to strengthen health care across our rural counties.

What Does This Mean for Your Practice?

• Significant Investment: The RHTP will support nearly 3 million rural North Carolinians and strengthen more than 400 rural health facilities statewide.
• Collaborative Approach: Implementation will involve state agencies, rural providers, community partners, academic institutions, and the private sector. This is a true team effort to improve health outcomes and care delivery.
• Governance and Regional Hubs: Once funding is received, NCDHHS will quickly establish a statewide governance structure and begin building regional hubs. Stakeholders—including practices like yours—will be engaged in funding and implementation decisions.

Get Involved: Virtual Town Hall

NCDHHS is hosting a virtual town hall to share program goals, next steps, and the anticipated statewide impact:

• Date: Friday, Jan. 16
• Time: 2:30–3:30 p.m.
• How to Join: Register using this link to attend via Zoom. You can also submit questions and join the RHTP mailing list during registration.

Why This Matters

• Expanded Resources: Expect new opportunities for funding, technical assistance, and collaboration to address rural health challenges.
• Practice Voice: Your input is needed! Participation in the town hall and ongoing engagement will help shape how resources are allocated and programs are implemented.
• Stay Informed: For updates and more information, be sure to opt in for the mailing list when using the registration link above.

Next Steps for Practice Managers

• Share this update with your teams and rural partners.
• Register for the town hall and encourage your staff to participate.
• Prepare questions or topics you’d like addressed—your feedback is essential.
• Watch for further communications from NCDHHS and our coaching team as implementation details emerge.