Medical Billing Services in North Carolina
A North Carolina Medicaid claim can belong in one of three places: NCTracks for NC Medicaid Direct and carved-out services, a Standard Plan, or a Tailored Plan. Medicare claims go to Palmetto GBA. We handle billing for North Carolina practices remotely across 15+ specialties.
Who Pays Medical Claims in North Carolina
The payer map for a North Carolina claim.
Jurisdiction M
North Carolina Part A and Part B claims go to Palmetto GBA, A/B MAC Jurisdiction M, which also covers South Carolina, Virginia and West Virginia. Palmetto also processes home health and hospice claims for the state. DME claims go to DME MAC Jurisdiction C, run by CGS Administrators.
NC Medicaid (NCTracks)
Run by the NC Department of Health and Human Services, Division of Health Benefits. Providers file claims electronically through NCTracks, which handles NC Medicaid Direct members and services carved out of managed care.
Standard and Tailored Plans
The Standard Plans are AmeriHealth Caritas North Carolina, Carolina Complete Health (which merged with WellCare of North Carolina on April 1, 2026), Healthy Blue and UnitedHealthcare Community Plan. Members with serious behavioral health needs, I/DD or a traumatic brain injury may be in a Tailored Plan from Alliance Health, Trillium Health Resources or Vaya Partners, the name Vaya Health and Partners Health Management took on October 1, 2026.
Plan names and enrollments have moved twice this year. We confirm each patient's plan at eligibility. Commercial and Medicare Advantage plans are billed under their own contracts.
North Carolina Medicaid Billing Rules to Know
From NC Medicaid guidance and state rule. Plans publish their own manuals, so check the payer before relying on a date.
365 days from the first date of service
Most Medicaid claims must reach NCTracks within 365 days of the first date of service. Inpatient hospital and nursing facility claims count from the last date of service. For dates of service on or after July 1, 2023, Standard Plans also use 365 days, for original and corrected claims.
Retroactive enrollment and late-filing exceptions
When a member is retroactively enrolled with a Standard Plan, claims are due within 365 days of the member's enrollment date. If it was not reasonably possible to file on time, a claim can still be accepted when it is submitted as soon as reasonably possible and no later than one year after it was otherwise due, unless the plan and provider have agreed otherwise.
Prompt-pay timelines for plans
NC Medicaid requires health plans to tell the provider within 18 calendar days whether a medical claim is clean or pended, and to pay or deny a clean claim within 30 calendar days. A pended claim gets 30 days after the plan receives the missing information, and the plan may deny it if nothing arrives in 90 days.
Sources: NC Medicaid Claims and Billing page; NC Medicaid Managed Care Billing Guidance to Health Plans (v32); NC Medicaid health plan, merger and Tailored Plan pages; CMS Who Are the MACs.
What Makes North Carolina Medical Billing Different
The part of NC billing we spend the most time on.
Why payer routing is the hard part in North Carolina
The same patient can sit in a Standard Plan, move to a Tailored Plan after an eligibility review, or be on NC Medicaid Direct, and carved-out services always go to NCTracks. Two mergers this year, WellCare into Carolina Complete Health in April and Vaya Health with Partners in October, changed plan names and member ID cards, so an old eligibility record points a claim at the wrong name. Checking the plan at every visit, as part of our eligibility verification, is what keeps a claim out of the wrong queue.
What We Handle for North Carolina Practices
Billing work for North Carolina Medicaid, Medicare and commercial payers.
Eligibility checks that separate NCTracks, Standard Plan and Tailored Plan members
Prior authorization requests and tracking with each plan
Medical coding and charge review
Claims to Palmetto GBA, NCTracks, the health plans and commercial payers
Denial management, appeals and A/R follow-up
Payment posting, patient statements and monthly reporting
Specialties We Support in North Carolina
15+ specialties served. Pick yours to see how we bill it.
North Carolina Medical Billing Questions
Short answers for North Carolina practices.
Who processes Medicare claims in North Carolina?
Palmetto GBA handles Part A and Part B as the A/B MAC for Jurisdiction M (North Carolina, South Carolina, Virginia and West Virginia), and also processes home health and hospice claims. DME claims go to CGS Administrators as DME MAC Jurisdiction C.
How long do I have to file a North Carolina Medicaid claim?
Most claims must reach NCTracks within 365 days of the first date of service, and inpatient hospital and nursing facility claims within 365 days of the last date of service. Standard Plans also use 365 days for dates of service on or after July 1, 2023.
Do I bill NCTracks or the health plan?
It depends on the member. Claims for members in a health plan go to the plan, except for carved-out services. NCTracks handles NC Medicaid Direct members and carved-out services. We check enrollment at eligibility.
What changed with WellCare and the Tailored Plans in 2026?
WellCare of North Carolina merged into Carolina Complete Health on April 1, 2026, and it is now a single Standard Plan. Vaya Health and Partners Health Management merged into Vaya Partners on October 1, 2026, with members enrolled automatically.
Which specialties do you support for North Carolina practices?
The 15+ specialties we support for North Carolina practices include behavioral health, laboratory, home health, hospice, infusion, sleep medicine, DME, dental, vision and ENT.
Can Salyx RCM bill for my North Carolina practice remotely?
Yes. We get secure access to your practice management or billing system and work remotely, wherever in North Carolina your practice is.
Find Out Which Payer Your North Carolina Claims Belong To
Start with a free billing audit: a review of your recent claims, denials and A/R, with a summary of what we found.