The North Carolina Department of Health and Human Services (NCDHHS) has announced the appointment of Melanie Bush as Deputy Secretary of NC Medicaid, pending confirmation by the North Carolina General Assembly. In this role, Deputy Secretary Bush will provide leadership and operational oversight for NC Medicaid, which serves more than 3 million North Carolinians across the state.
Did you know that interlibrary loan (ILL) services are available through your regional AHEC library? These services are designed to support your learning, teaching, and clinical work by helping you access resources beyond what’s immediately available in your local or digital collection.
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If you’re searching for a journal article, book chapter, or other scholarly resource that isn’t found in the AHEC Digital Library (ADL), your local AHEC library staff may be able to request it for you through interlibrary loan—often for a small fee. This service helps ensure you have timely access to the information you need, even when it comes from outside the AHEC network.
Getting started is easy! Visit https://library.ncahec.net, click “HOME,” then select “Regional Libraries” to find contact information for your local AHEC library. Library staff are happy to answer questions, help track down hard-to-find resources, and guide you through the request process.
We look forward to helping you with all your library and research needs—don’t hesitate to reach out and make the most of the resources available to you!
The Northwest AHEC Library provides information resources, services, classes, and consultations to further the Northwest AHEC mission.
Begun as a circuit-riding, decentralized consortium program with four base libraries in the early 1970s, our library network has evolved alongside changes in health systems and technology.
Northwest AHEC cost-shares the expenses of library operations with its partners. For each new fiscal year, all library expenses are estimated using the most current data available, and Northwest AHEC is committed to paying 50% of the estimated total.
We provide a full-service, world-class library program to our members, while also supporting area health careers students and licensed/credentialed health care professionals.
Library staff also provide professional information support to Northwest AHEC staff through collaboration on continuing professional development initiatives, serving as presenters when appropriate, and offering information services presentations and displays to enhance professional development programs and workshops.
The Northwest AHEC Practice Support team have several important updates to share following the recent merger of WellCare of North Carolina Medicaid and Carolina Complete Health (CCH), effective April 1, 2026. These updates address provider portal access issues, claim reprocessing timelines, and revised billing guidance for antepartum care.
Carolina Complete Health has identified an issue affecting provider access to the WellCare Secure Provider Portal following the merger. Practices that previously held only a WellCare of North Carolina Medicaid contract—and no other WellCare contracts—may currently be unable to log in.
This issue has been escalated due to its impact on historical claims activity. A fix has been identified and was deployed April 3, 2026. Once deployed, providers should again be able to access the WellCare Secure Provider Portal to submit and review claims with dates of service prior to April 1, 2026.
It is important to note that while claims access is expected to be restored, some wraparound functions (including consent forms and the claim reimbursement calculator) will not yet be available as work continues to fully restore portal functionality.
Additional details are available here.
While portal access is being restored, providers can continue submitting Medicaid claims with dates of service prior to April 1, 2026 through existing electronic pathways. Claims may be submitted via Availity Essentials by selecting WellCare of North Carolina as the payer, or by EDI using WellCare Payer ID 14163.
Once portal access is fully restored, the WellCare Secure Provider Portal will again be available for historical claims submission and review.
Claim submission for services provided on or after April 1, 2026 is not impacted by the portal issue. Providers should continue submitting these claims to Carolina Complete Health using their established workflows, including the Carolina Complete Health Secure Portal, Availity Essentials (selecting Carolina Complete Health as the payer), or EDI using Payer ID 68069.
An update is also available regarding WellCare claim reprocessing related to the rate rebase reversal. WellCare did not meet NC DHHS-established timelines for completion, but the claims team is providing regular progress updates.
To date, over 508,146 claims have been adjusted and moved to payment, with the remaining claims continuing to be processed daily. The team is currently on track to complete reprocessing by April 30, inclusive of all North Carolina tickets received year to date, with remaining activity tracking through April. Any changes to this timeline will be shared as soon as they are known.
Carolina Complete Health has also revised its guidance on antepartum billing and coding following a clarification request. Under North Carolina Medicaid Clinical Coverage Policy, CPT code 59426 must be billed using the date of delivery as the date of service.
As a result, if the delivery date occurred prior to April 1, 2026, the claim should be billed to WellCare, even when antepartum visits span the merger date. Practices may be advised that antepartum care beginning before April 1 should continue to be billed to WellCare, even if some visits took place after April 1.
Healthy Blue has released two updated resources to support Medicaid providers as they prepare for HEDIS® Measurement Year 2026. These tools are designed to help practices stay current with evolving measure specifications while strengthening documentation, coding accuracy, and overall quality performance for Healthy Blue Medicaid patients.
Both resources are especially useful for practices participating in Advanced Medical Home (AMH) programs, quality improvement initiatives, and value‑based arrangements where accurate HEDIS reporting and reliable data capture are essential.
The Healthy Blue HEDIS 2026 Desktop Reference Guide provides a high‑level, measure‑by‑measure overview of HEDIS quality requirements for Medicaid providers. It includes concise descriptions of each measure, eligible populations, exclusions, measurement timing, and documentation expectations. The guide is intended to serve as a quick reference for clinical and quality teams who need to understand what counts for HEDIS without navigating full technical specifications.
This resource is particularly helpful during visit workflows, chart reviews, and quality planning discussions. By summarizing key requirements across preventive care, chronic disease management, behavioral health, maternal health, and pediatric measures, the Desktop Reference Guide helps teams focus on capturing the right information at the point of care. It also reinforces how routine clinical actions—such as timely follow‑up, screenings, and assessments—contribute directly to quality scores and reporting outcomes.
Download the Healthy Blue HEDIS 2026 Desktop Reference Guide (PDF)
The Healthy Blue HEDIS 2026 Coding Booklet is a detailed companion resource that focuses on the “how” behind HEDIS reporting. It includes diagnosis, procedure, and service codes associated with each measure, along with practical documentation tips to support accurate claims submission and data capture. The Coding Booklet helps reduce gaps between care delivered and care reported—an essential step for reliable HEDIS performance.
This resource is especially valuable for billing staff, quality specialists, and clinical team members responsible for documentation accuracy. Clear coding guidance can help decrease the need for medical record reviews, reduce audit risk, and support appropriate reimbursement. For practices using electronic medical records, the Coding Booklet can also inform workflows, order sets, and reminders that improve consistency across providers and staff.
Download the Healthy Blue HEDIS 2026 Coding Booklet (PDF)
Two decades of partnership, adaptability, and practice transformation across Northwest North Carolina
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For twenty years, Practice Support at Northwest Area Health Education Center (AHEC) has worked alongside primary care practices, health departments, community health centers, and regional partners to strengthen care delivery across Northwest North Carolina.
What began as hands‑on assistance for practicing clinicians has grown into a core service line—one defined by long‑term relationships, responsiveness to change, and a sustained commitment to helping practices navigate complexity while keeping patient care at the center.
Practice Support emerged during a period when independent and community‑based practices were facing increasing administrative, clinical, and technology demands. Early efforts focused on meeting practices where they were—providing direct, practical assistance that complemented Northwest AHEC’s longstanding strengths in continuing professional development and workforce education.
From the beginning, the work emphasized trust, accessibility, and relevance. Rather than offering one‑size‑fits‑all solutions, Practice Support staff partnered with practices to understand their workflows, constraints, and goals, helping them respond to evolving expectations without losing sight of patient needs.
By the early 2010s, Practice Support had become a formally recognized core service of Northwest AHEC. Annual reports from this period reflect its growing role alongside other essential AHEC functions, signaling both expansion in scope and clarity of purpose.
During this phase, Practice Support increasingly focused on:
This shift marked an important transition—from episodic technical assistance to sustained partnership. Practice Support was no longer supplemental; it was central to how Northwest AHEC supported the practicing health care workforce.
“I wanted to give a BIG shout‑out to our AHEC folks. They are valuable resources for us, so if you don’t know who your people are—find out. A special shout‑out to our Northwest AHEC team, who recently assisted us with valuable training for my staff. They worked with us to determine our needs and delivered practical training and tactics on how to handle disruptive patients and navigate uncomfortable situations while maintaining professionalism and continuing to care for our patients—and most importantly, our staff. Once again, thank you, Lara and Medina.”
— Melissa H. White, Practice Administrator, Newton Family Physicians, P.A.
As health care delivery models continued to evolve, Practice Support expanded its capacity to meet growing demand. Engagement shifted from short‑term problem solving to long‑term collaboration, helping practices build internal systems and confidence rather than simply responding to immediate challenges.
Practices worked with Practice Support on a wide range of issues, including:
This period reinforced the importance of consistency—having a knowledgeable, trusted partner who understood both policy expectations and day‑to‑day practice realities.
“Working directly with rural health centers reminds us that meaningful practice support starts with listening. By spending time onsite—reviewing data, understanding community needs, and planning next steps together—we’re able to support practices in ways that are practical, collaborative, and grounded in the realities they face every day.”
— Medina Wilson, Senior Practice Support Quality Improvement Specialist, Northwest AHEC
Periods of disruption—whether driven by policy shifts, technology changes, or public health emergencies—highlighted a defining characteristic of Practice Support: adaptability.
Even as practice environments changed rapidly, Practice Support remained focused on continuity,
helping practices adjust workflows, maintain quality initiatives, and stay connected to regional and statewide partners. Virtual engagement and customized support allowed practices to continue progress toward goals despite unprecedented challenges.
In the early 2020s, Practice Support’s role increasingly intersected with Medicaid transformation and whole‑person care initiatives. Documented work during this period reflects support for new workflows, quality projects, and approaches that bridged clinical care, operations, and community resources.
Practice Support helped practices translate complex policy changes into actionable steps—supporting both compliance and sustainability while keeping the focus on patient care.
By the mid‑2020s, Practice Support Services were clearly identified as a core, integrated component of Northwest AHEC’s strategy. Work during this period reflects broad regional reach and collaboration with independent practices, federally qualified health centers, rural health clinics, and health departments.
The emphasis is not only on scale, but on depth—maintaining long‑term relationships that allow Practice Support to respond quickly and effectively as practice needs evolve.
Twenty years into this work, Practice Support at Northwest AHEC continues to evolve—shaped by health system transformation, policy change, and the voices of the practices it serves.
What has remained constant is a commitment to partnership: meeting practices where they are, building trust over time, and translating complexity into clear, actionable support. As Northwest AHEC looks ahead, Practice Support’s future will continue to be written in collaboration with the practices and communities that make this work possible.
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The Centers for Medicare & Medicaid Services (CMS) has finalized a major Administrative Simplification rule that will modernize how health care claims attachments are exchanged across the health care system. Known as CMS‑0053‑F, this final rule establishes, for the first time, national HIPAA standards for the electronic submission of health care claims attachments—such as medical records, imaging, clinical notes, and laboratory results—replacing long‑standing manual processes like faxing, mailing, and portal uploads.
CMS fact sheet on the final rule
Despite widespread adoption of electronic health records and HIPAA transaction standards, the exchange of claims attachments has remained largely manual for many practices. When payers request additional documentation to adjudicate a claim, practices have often relied on fax machines, scanned PDFs, or mailed records—contributing to delays, administrative burden, and rework.
The CMS‑0053‑F final rule addresses this gap by establishing standardized, interoperable electronic transactions for claims attachments. CMS estimates the rule will save the health care industry approximately $781 million annually, largely by reducing administrative overhead and shortening claims processing timelines.
Overview of expected savings and impact
This rule is focused specifically on health care claims attachments. It does not apply to prior authorization attachments. CMS intentionally narrowed the scope of the final rule after extensive stakeholder feedback, noting that additional work is needed to align prior authorization standards with existing regulations and workflows.
Details from the Federal Register notice
The final rule adopts updated national standards that support secure, structured electronic exchange of both administrative and clinical information tied to claims. These include:
Together, these standards are designed to support faster, more reliable claims adjudication while strengthening data security and interoperability across payers, providers, clearinghouses, and vendors.
CMS summary of adopted standards
The rule is effective May 26, 2026, with a 24‑month compliance period, meaning covered entities must be compliant by May 26, 2028. CMS is encouraging health plans, providers, and technology partners to begin preparing now to ensure a smoother transition and avoid last‑minute implementation challenges.
Effective and compliance dates
Although compliance is still two years away, early preparation can help practices minimize disruption and take advantage of the efficiencies this rule is intended to deliver. Practices may want to:
CMS‑0053‑F represents a significant step toward reducing administrative burden and modernizing claims processing nationwide. By replacing fragmented, manual attachment workflows with standardized electronic transactions, the rule aims to help practices spend less time on paperwork and more time focused on patient care—while improving efficiency, security, and consistency across the health care system.
For many practices, the next two years will be an opportunity to streamline workflows, strengthen partnerships with technology vendors, and prepare for a more interoperable future.
CMS has corrected an issue affecting certain Medicare Physician Fee Schedule payments under the Quality Payment Program (QPP). This correction is tied to the 2026 update to the conversion factor for qualifying and nonqualifying Alternative Payment Models (APMs) and will result in automatic claim adjustments for impacted providers.
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New federal accessibility rules are changing how healthcare facilities must think about exam tables, weight scales, and other diagnostic equipment. These updates are not about convenience or optional upgrades. They are about ensuring that patients who use wheelchairs or have mobility limitations can be weighed, examined, and transferred safely and with dignity—without being examined in their chair or turned away because appropriate equipment is not available.
Two federal actions work together to create these new expectations: updated technical standards from the U.S. Access Board and enforceable legal requirements from the Department of Justice (DOJ). Understanding how they fit together is key for planning, budgeting, and compliance.
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NCTracks, North Carolina Medicaid’s claims and payment system, has identified an issue affecting certain Electronic Remittance Advice (ERA) files, also known as 835 files. While the actual Medicaid payments deposited to providers were generally correct, some of the remittance files explaining those payments were not.
NCTracks has corrected the system issue and is regenerating the affected 835 files. If your practice received Medicaid payments earlier this year, it’s important to understand what happened, whether you are affected, and how to handle the corrected files when they become available.
What is an 835?
An 835 is an Electronic Remittance Advice (ERA) file. It explains how a Medicaid payment was calculated, including which claims were paid, denied, or adjusted; how much was paid; and why amounts may have been reduced, reversed, or recouped. In short, the 835 is what allows billing systems to post and reconcile Medicaid payments correctly.
What does “out‑of‑balance 835 remittance file” mean?
An 835 is considered out of balance when the total payment amount in the file does not match the sum of the individual claim‑level payments and adjustments listed inside the file. When this happens, it can be difficult or impossible to post payments accurately, reconcile deposits, or trust that the ERA truly reflects the payment received.
What is “negative claim activity”?
Negative claim activity usually includes recoupments, voids, reversals, or adjustments where money is taken back. These transactions are common in Medicaid billing, but they must be calculated precisely. In this case, negative claim activity contributed to the 835 files being out of balance.
The issue affects 835 remittance files with check or payment dates between January 6, 2026 and March 10, 2026. If your practice received NC Medicaid payments during this period, your 835 files may be incorrect even if the deposit amount itself appears right.
NCTracks has identified and corrected the underlying system problem. To fix the issue, NCTracks is regenerating all affected 835 remittance files.
The regeneration is scheduled to occur on March 12 and March 13, 2026, and the corrected 835 files will be available on or before March 15, 2026. These regenerated files are intended to fully replace the original, out‑of‑balance remittances.
Expect replacement 835 files.
The regenerated 835s will replace the original versions and should now balance correctly, including claims with negative adjustments.
Use caution if you already posted payments.
If your billing team already posted payments using the original 835 files, or noticed discrepancies that did not make sense, you may need to reconcile or re‑post those payments using the regenerated files. Practices should also watch carefully for duplicate postings in their practice management or EHR system.
To avoid compounding errors, practices should not rely on original 835 files with payment dates between January 6 and March 10, 2026. Once the regenerated files are available, download them and reconcile payments carefully, paying close attention to recoupments, takebacks, and adjusted claims.
If amounts still do not reconcile after using the regenerated 835s, contact the NCTracks Provider Call Center or flag the issue internally for audit tracking and follow‑up.
Taking time now to verify and correct posting will help prevent downstream reporting issues, audit concerns, and inaccurate patient or payer balances later.
Early identification and high‑quality care can make a meaningful difference for autistic children and their families. In partnership with Wellcare, we are inviting North Carolina primary care providers to deepen their expertise in autism screening, evaluation, and ongoing care through a collaborative, case‑based learning experience.
Project ECHO Autism – Medical, led by UNC TEACCH, connects primary care clinicians with an interdisciplinary team of autism specialists through a virtual learning model designed to fit into busy clinical schedules. Participants gain practical, evidence‑based knowledge while learning alongside peers who share similar clinical challenges.
The Project ECHO Autism series meets virtually on the 1st and 3rd Mondays of each month from 12:30–2:00 PM, beginning May 4, 2026. Sessions combine short didactic presentations with real‑world case consultation, allowing participants to apply new knowledge directly to patient care. Topics focus on improving screening practices, strengthening diagnostic understanding, and enhancing confidence in caring for autistic children across the continuum.
In addition to clinical learning, participants receive free continuing medical education (CME) credits, contact hours, and continuing education units (CEUs) for attending sessions—removing cost as a barrier to participation.
This series is designed for primary care providers in North Carolina who care for children and want to strengthen their skills in autism‑related screening, evaluation, and management. No prior specialty training in autism is required—just a commitment to learning and improving care for patients and families.
Full details, including session dates, topics, and registration information, are available on the Project ECHO Autism – Medical website
