NC Medicaid Partnership Changes

As you may know, NC Medicaid has a contractual partnership with NC AHEC that funds much of our Practice Support work. Due to statewide budget pressures, this contract and related funding are being substantially reduced.

These changes require us to prioritize how we deliver support moving forward. While this may affect the breadth of services we can offer, our commitment to North Carolina practices remains steadfast. We are deeply proud of what we’ve achieved together - and we remain dedicated to helping practices continue to deliver high-quality, patient-centered care.

The Southern Regional AHEC Practice Support team will continue to serve as a trusted resource for your practice

Meet Your Practice Support Coaches

Our experienced Practice Support Coaches are available to help you navigate changes, implement quality improvement initiatives, and strengthen care delivery.

Donna Bowen

Email: donna.bowen@sr-ahec.org

Office: (910) 678-0119 | Cell: (910) 624-0528

Alexis Jacobs

Email: alexis.heller@sr-ahec.org

Office: (910) 678-7234 | Cell: (910) 929-2754

Paula Locklear

Email: paula.locklear@sr-ahec.org

Office: (910) 678-7316 | Cell: (910) 580-8602

Jane Moran

Email: jane.moran@sr-ahec.org

Office: (910) 678-0113

Medicaid Managed Care

• Member Ombudsman - This service discontinues for Medicaid members December 31, 2025. The Provider Ombudsman service remains in place.
• PCP/AMH Auto - Assignment Guidance FAQ
• FQHC & RHCs - Well Child Visits: Effective Nov. 9, 2025, retroactive back to May 1, 2024, Federally Qualified Health Center (FQHC) and Rural Health Center (RHC) claims will be updated to process Well Child Visit procedures (99381\EP–99385\EP and 99391\EP–99395\EP) as core services, with updates to pricing and editing. This update will also enable providers to submit non-core ancillary services on the same claim as core services. Non-core services will finalize in a paid status with a reimbursement amount of $0.
• Reimbursement Rate Reductions - The North Carolina Department of Health and Human Services (NCDHHS) remains committed to transparency, collaboration, and fiscal responsibility in administration of the NC Medicaid program. Fee schedules impacted by rate reductions were released Oct. 1, 2025, but are subject to change if additional appropriations are made available. NC Medicaid provider reimbursement rate reductions are being implemented by the Division of Health Benefits (DHB) to maintain the NC Medicaid program within the current funding allocated to the Medicaid program by the North Carolina General Assembly (NCGA). For more information, please see:

-Medicaid Provider Bulletin Article - NC Medicaid Rate Reductions -

Effective Oct. 1, 2025

-Rate Reduction Questions and Answers - Oct. 1, 2025

• Wellcare QI Presentation on EPSDT & Coding
• Rebase Rate Reductions Update
• Children and Family Specialty Plan (CFSP) NC Medicaid Back Porch Chat

-CFSP Contracting Information: Practices interested in contracting

with Healthy Blue Together CFSP, must contact

NC_Contracting@healthybluenc.com. Providers currently contracted

with Healthy Blue are not automatically enrolled into CFSP.

• Wellcare Provider Engagement Information

HIT

• Medicaid Claims Data Available in NC HealthConnex Clinical Portal - Medicaid claims data will be visible in the NC HealthConnex Clinical Portal beginning Oct. 2, 2025. Look for this update on the left-hand navigation of the chartbook section of the portal. The Clinical Portal User Guide will be updated to reflect this change.
• NC HIEA Office Hours – Tuesday, Nov. 18, 2025 – 12 p.m. to 1 p.m. Register Here.
• Medicare Telehealth Coverage Uncertain Post - Oct. 1 - Restrictions on Patient Location (Originating Site) for Medical Visits Return: While Medicare will keep paying health centers for medical visits provided via telehealth through December 31, starting on Oct. 1, all Medicare patients (not just those treated by FQHCs) will only be allowed to receive services via telehealth if they are physically at an FQHC (or other medical facility) that is located in a rural HPSA, or a county that is not a Metropolitan Statistical Area. CMS clearly intended to shield FQHC patients from this outcome in the CY25 Physician Fee Schedule regulation. However, it now appears that CMS was unsuccessful in taking all the steps needed to ensure uninterrupted access for FQHC patients.
• Athena Health & TEFCA

Collaborative Care

• Medicaid Collaborative Care Bulletin Updated (9/17) - Includes updated coding guidance with G0512 for FQHCs/RHCs and clarification that 99494 is allowed to be billed up to 4 times per month. This code requires a minimum of 60 minutes per calendar month.
• Wisconsin Medical Journal Article (Vol. 114 No. 5) - Collaborative Care Reduces Stress and Increases Job Satisfaction and Comfort Prescribing for Primary Care Providers.
• CoCM Codes - Medicaid Fee-for-Service Reimbursement Summary (10/5/25) – A state-by-state comparison. In the upper right corner of the pdf is a link to more detailed Medicaid Reimbursement Info By State

Practice Manager Academy

• The Sane Practice Manager Podcast - Brought to you by Jane Moran and the Practice Manager Academy. An informative and light-hearted new podcast that explores topics important to practice managers who are navigating the ever-changing, crazy-making world of healthcare. In this intro episode, Wisdom for New Practice Managers, Matt Johnson, MBA offers advice and encouragement for practice managers assuming this vitally important role for the first time.
• PMA Course on Customer Service

Medicare Quality Payment Program

• The Centers for Medicare & Medicare Services (CMS) has released Merit-based Incentive Payment System (MIPS) payment adjustment information for the 2024 performance period/2026 MIPS payment year. The 2024 MIPS final score determines the MIPS payment adjustment that practices will receive in 2026. A positive, negative, or neutral payment adjustment will be applied to the Medicare paid amount for covered professional services furnished in 2026.
• Updates to Medicare Shared Savings Program - Notice Medicare quality measures, removal of SDoH screenings, and malware/cyberattack as qualifying EUC

Learning Opportunities: In-Person or Live Webinar

Family First: Supportive Pathways for Military Families

November 12, 2025 | In-Person – Fayetteville, NC

Managing Pain in Older Adults: Evidence Based Strategies for Chronic Pain Relief

November 13, 2025 | Live Webinar

Everything in Balance: Aligning Team Culture with Ethics

November 13, 2025 | Live Webinar

Advanced Acceptance and Commitment Therapy (ACT): Enhancing Psychological Flexibility

November 14, 2025 | Live Webinar

NC AHEC 8th Annual Statewide Celebration of Rural Nursing

November 14, 2025 | Live Webinar

Coronal Polishing for the DA

November 14, 2025 | In-Person – Fayetteville, NC

Stop the Bleed

November 18, 2025 | In-Person

Voices of Resilience: Suicide Prevention in Native Communities

November 19, 2025 | Live Webinar

Differentiating Chest Pain: Identifying Acute Coronary Syndromes

November 20, 2025 | Live Webinar

Customer Service (Practice Manager Bootcamp)

November 13, 2025 – November 20, 2025 | Live Webinar

Click here to see our full course catalog.