Do you handle both NC Medicaid Managed Care and Medicaid Direct?

Yes, as separate payers, with eligibility confirming which applies before the claim is submitted.

Do you check for underpayments from commercial payers?

Yes. Payments are posted line by line and reconciled against the contracted rate, and variances are worked rather than written off.

Can you credential providers in North Carolina?

Yes, including state enrollment and Standard Plan participation, quoted per provider.

Do we have to switch practice management systems?

No. We work inside the system you already use, and your data stays yours if you ever leave.

North Carolina

Medical billing for North Carolina practices

North Carolina moved most of its Medicaid population into managed care, which split one payer into several with different rules. Practices that still bill NC Medicaid as a single payer are the ones with unexplained denials.

Standard Plan or Medicaid Direct

These are effectively different payers. Eligibility is checked to establish which one covers the patient on the date of service, before the claim goes out, because a Standard Plan claim sent to Medicaid Direct is not a slow payment — it is a denial that has consumed part of the filing window.

A dominant commercial payer means rate accuracy matters

Where one commercial payer covers much of the market, the contracted rate is most of the revenue and an underpayment repeated across a year is significant. Payments are reconciled against expected rates line by line so short payments surface as variances rather than closing quietly as paid.

Credentialing through the transition

Practices adding providers need enrollment with the state and participation with each Standard Plan they bill. Both are tracked per provider with revalidation dates held against deadlines, so a new provider is billable from their start date rather than three months later.

NC Medicaid

Members are either in a Standard Plan or remain in NC Medicaid Direct, and the two do not share submission rules or authorization requirements. Which one a patient is in determines where the claim goes.

Program: NC Medicaid
Administered by: NC Department of Health and Human Services
Managed care: NC Medicaid Managed Care Standard Plans, alongside NC Medicaid Direct

Payers we work in North Carolina

Blue Cross and Blue Shield of North Carolina
UnitedHealthcare
Aetna
Cigna
Humana
NC Medicaid Standard Plans

Not an exhaustive list, and not a claim of network participation on your behalf — your contracts are yours. It is the payer mix we are set up to work in North Carolina.

Services available to North Carolina practices

Billing in North Carolina — common questions

Do you handle both NC Medicaid Managed Care and Medicaid Direct?: Yes, as separate payers, with eligibility confirming which applies before the claim is submitted.
Do you check for underpayments from commercial payers?: Yes. Payments are posted line by line and reconciled against the contracted rate, and variances are worked rather than written off.
Can you credential providers in North Carolina?: Yes, including state enrollment and Standard Plan participation, quoted per provider.
Do we have to switch practice management systems?: No. We work inside the system you already use, and your data stays yours if you ever leave.

Everywhere else

All billing services

Next step

Start with the free A/R review.

Send an aging summary and a handful of denials. You get a written read on what is recoverable — no fee, no obligation to sign anything.

Book the A/R review See pricing