North Carolina billing is a routing challenge. Most Medicaid members are in managed care Standard Plans, some remain in fee-for-service, and members with significant behavioral health needs are in separate Tailored Plans, and a claim sent to the wrong one of those is a denial no matter how clean it is. Since Medicaid expansion, the managed care caseload has grown sharply, which makes plan-level verification on every visit the single biggest lever on collections.
MedPlus RCM provides medical billing, coding, credentialing, and denial management for North Carolina practices of every specialty, built around the state’s actual payers and programs.
North Carolina’s payer landscape
North Carolina Medicaid is delivered primarily through NC Medicaid Managed Care Standard Plans, run by prepaid health plans: AmeriHealth Caritas North Carolina, Carolina Complete Health, Healthy Blue, UnitedHealthcare Community Plan, and WellCare. A smaller share of members remain on NC Medicaid Direct (fee-for-service), and members with significant behavioral health needs are served through Tailored Plans run by regional organizations including Alliance Health, Trillium Health Resources, Vaya Health, and Partners Health Management. Each Standard Plan has its own portal, prior-authorization rules, and filing window.
Commercial coverage is led decisively by Blue Cross and Blue Shield of North Carolina, alongside Aetna, Cigna, and UnitedHealthcare. Commercial mental health benefits are frequently carved out to a managed behavioral health organization, so a clinician in-network with the medical carrier can still be denied by the vendor that owns the therapy benefit, a routing check we perform before the claim goes out.
What MedPlus RCM handles for North Carolina practices
- End-to-end medical billing. Charge entry, claim scrubbing, submission, payment posting, and patient billing, the full cycle.
- Medical coding. Certified coders assign current ICD-10, CPT, and HCPCS codes matched to your documentation and specialty.
- Provider credentialing and enrollment. End-to-end enrollment with Standard Plans, Tailored Plans, NC Medicaid Direct, commercial payers, and Medicare, plus re-credentialing maintenance.
- Denial management and recovery. Every denial investigated to root cause, corrected, and appealed with documentation.
- A/R recovery. Aged and outstanding balances audited and pursued, including balances already written off where the appeal window is still open.
- Financial reporting. Clean claim rates, collections, denial patterns, and A/R aging visible by payer and provider.
We serve practices statewide, Charlotte, Raleigh, Greensboro, Durham, and Winston-Salem, across specialties including primary care, mental and behavioral health, cardiology, orthopedics, dermatology, and physical therapy.
Results North Carolina practices can check
MedPlus RCM maintains a 99% clean claim rate and keeps client accounts receivable under 30 days. Pricing is a performance-based percentage of successfully collected revenue: if you don’t get paid, we don’t get paid. We are 100% HIPAA compliant, and onboarding takes 2 to 4 weeks depending on practice size, with no disruption to your daily cash flow.
Frequently asked questions
What is the difference between a Standard Plan and a Tailored Plan?
Standard Plans cover most Medicaid members through prepaid health plans. Tailored Plans serve members with significant behavioral health and related needs through regional organizations. Billing the wrong one is a denial, so we confirm the member’s plan at eligibility, before the visit.
Do you work with NC Medicaid Standard Plans?
Yes. We bill AmeriHealth Caritas North Carolina, Carolina Complete Health, Healthy Blue, UnitedHealthcare Community Plan, and WellCare, as well as NC Medicaid Direct, Tailored Plans, and commercial and Medicare plans.
How long does it take to switch our billing to MedPlus RCM?
Onboarding takes between 2 and 4 weeks depending on practice size, including data migration and payer clearinghouse setup.
What does MedPlus RCM charge?
A performance-based percentage of successfully collected revenue. If you don’t get paid, we don’t get paid.
Get a free financial audit
Find out where your North Carolina practice is losing revenue. Request a free financial audit and our specialists will review your claims, denials, and A/R.
