Medical Billing Services in North Carolina
Billing, coding, credentialing and denial management for North Carolina practices, with Medicare claims through Palmetto GBA (Jurisdiction JM) and North Carolina Medicaid handled by people who know the rules.
Medical billing for North Carolina practices
North Carolina moved most Medicaid members into managed care in 2021 and expanded Medicaid on December 1, 2023. NC DHHS reported more than 690,000 newly eligible residents had gained coverage by December 2025. Practices now bill Standard Plans, Behavioral Health I/DD Tailored Plans and NC Medicaid Direct, often for the same patient over time. Commercial volume is led by Blue Cross NC, with large Medicare populations in retirement areas like the coast and the western mountains.
Medicare Part B claims go to Palmetto GBA in Jurisdiction M. Fee-for-service Medicaid claims run through NCTracks. SFA Solutions works with practices across North Carolina remotely from Austin, from Charlotte and the Triangle to rural eastern counties, verifying the right plan before each visit and submitting most clean claims within 24 hours.
North Carolina at a glance
| Medicare contractor | Palmetto GBA, Jurisdiction JM |
|---|---|
| Medicaid timely filing | 365 days from the first date of service for NC Medicaid Direct (fee-for-service) claims; health plans set their own limits by contract |
| NP practice authority | Restricted |
| Cities we serve | Charlotte, Raleigh, Greensboro, Durham, Winston-Salem, Fayetteville, Wilmington, Asheville, Cary, Greenville |
What North Carolina billing involves
These are the programs and rules our team works with for North Carolina claims.
Medicare
Palmetto GBA · JMNorth Carolina Part B claims are processed by Palmetto GBA in Jurisdiction JM. Medicare's filing limit is 12 months from the date of service, and appeals start with a redetermination within 120 days of the initial decision.
North Carolina Medicaid
NC Medicaid, administered by the NC Department of Health and Human Services; NC Medicaid Managed Care and NC Medicaid Direct (fee-for-service)
Portal: NCTracks for provider enrollment, credentialing and fee-for-service claims, operated for NC DHHS
Medicaid managed care
Standard Plans are AmeriHealth Caritas North Carolina, Healthy Blue, UnitedHealthcare Community Plan (all statewide) and Carolina Complete Health (Regions 3, 4 and 5). Behavioral Health I/DD Tailored Plans are run by Alliance, Partners, Trillium and Vaya, and Healthy Blue Care Together is the statewide Children and Families Specialty Plan.
Timely filing
365 days from the first date of service for NC Medicaid Direct (fee-for-service) claims; health plans set their own limits by contract.
Commercial and Medicare Advantage
Blue Cross and Blue Shield of North Carolina is the largest commercial carrier, with UnitedHealthcare, Aetna and Cigna also active. Humana and UnitedHealthcare both offer Medicare Advantage plans across the state.
Prompt pay law
North Carolina law requires insurers to pay, deny or request more information within 30 calendar days after receiving a claim (N.C.G.S. 58-3-225). The same statute bars insurers from setting a filing limit shorter than 180 days.
Nurse practitioners
Restricted practiceNorth Carolina NPs must practice under a collaborative practice agreement with a primary supervising physician, and they are regulated jointly by the Board of Nursing and the Medical Board. Payers credential NPs individually, but the agreement must be in place and current before enrollment.
Credentialing
NC Medicaid enrollment and credentialing happen centrally through NCTracks, and the health plans rely on that enrollment, though each plan still requires its own contract. Blue Cross NC, UnitedHealthcare and Aetna use CAQH ProView. NCTracks sends reverification notices on a set cycle, and missing one can end-date the provider record.
Billing challenges North Carolina practices face
Several Medicaid delivery systems
A Medicaid patient can be in a Standard Plan, a Tailored Plan or NC Medicaid Direct, and the assignment can change. Billing the wrong entity is a common denial, so eligibility has to be checked on the date of service.
Expansion adults and new enrollees
Medicaid expansion in December 2023 brought many first-time members into the system. These patients often do not know their plan assignment, which makes front-desk eligibility checks essential.
NCTracks record maintenance
Provider records in NCTracks must be kept current, including locations, taxonomy and reverification. An outdated record can stop payment from NC Medicaid Direct and from health plans that rely on it.
Our services in North Carolina
Medical Billing
Learn moreCredentialing & Payer Enrollment
Learn moreMedical Coding
Learn moreDenial Management
Learn moreA/R Recovery
Learn moreEligibility Verification & Prior Authorization
Learn moreMedical Billing Audit
Learn moreRevenue Cycle Management
Learn moreSpecialties we bill in North Carolina
North Carolina medical billing questions
What is the timely filing limit for NC Medicaid?
NC Medicaid Direct claims must be received by NCTracks within 365 days of the first date of service. Standard Plans and Tailored Plans set their own limits by contract, so check each plan's provider manual.
How fast must North Carolina insurers pay claims?
Under N.C.G.S. 58-3-225, insurers have 30 calendar days after receipt to pay, deny or request additional information. Insurers also cannot require claims to be filed sooner than 180 days after the service.
Who is the Medicare contractor for North Carolina?
Palmetto GBA processes Medicare Part A and Part B claims for North Carolina under Jurisdiction M. Palmetto also publishes the local coverage determinations that apply to your claims.
Do NC Medicaid health plans credential providers separately?
NC Medicaid handles credentialing centrally through NCTracks, and plans rely on that enrollment. You still need a signed contract with each Standard Plan or Tailored Plan to be in network.
Get a free billing audit for your North Carolina practice
We will review your recent claims and denials against North Carolina payer rules and show you what can be recovered.
Nearby states
Primary sources
- CMS: Who are the MACs, A/B MAC Jurisdiction M (JM)
- NC Medicaid health plans
- NC Medicaid claims and billing
- NC DHHS: North Carolina Celebrates Two Years of Medicaid Expansion
- N.C.G.S. 58-3-225
- NC Board of Nursing: Nurse Practitioner Scope of Practice
Payer rules change. Last reviewed against the primary sources above on . Confirm current rules with the payer before relying on them.
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