Issued: December 23, 2025
As previously communicated in a Provider Alert dated Dec. 22, 2025, Partners shared information from the North Carolina Department of Health and Human Services (NCDHHS) regarding the reversal of Medicaid reimbursement rate reductions.
In a follow-up communication, the Tailored Plans (all four local management entities/managed care organizations [LME/MCOs]) and Standard Plans are providing the process that will be followed to reverse those fee cuts. Click here to read the complete joint document.
What is happening?
The state’s Tailored Plans (Partners, Alliance, Trillium and Vaya) and Standard Plans (WellCare, UnitedHealthcare Community Plan, HealthyBlue, AmeriHealth Caritas and Carolina Complete Health) have outlined a process to reverse the Oct. 1, 2025, Medicaid reimbursement rate reductions. Details can be found here.
What do providers need to know?
- Any outstanding recoupments related to the Oct. 1, 2025, fee schedule changes are cancelled effective immediately.
- NCDHHS will issue updated fee schedules.
- All Tailored Plans and Standard Plans will implement the reversed fee schedules as soon as possible, but no later than 45 days following NCDHHS’s issuance of revised fee schedules. (Currently, NCDHHS is targeting Jan. 5, 2026, as the date for the updated fee schedules.
- NCDHHS is also restoring coverage for GLP-1 medications for weight management.
What do providers need to do?
- Providers should read the complete joint document.
- All health plans will begin reprocessing claims as soon as possible. Providers are not required to submit new claims for reprocessing.
- Providers must resubmit previously denied or end-dated prior authorizations from Oct. 1, 2025, through Dec. 2025 for GLP-1 medications for weight loss management.
Who can providers contact if they have questions?
If providers have questions, they can:
- Email Rates@PartnersBHM.org for rate-related questions.
- Email ClaimsDepartment@PartnersBHM.org for claims questions.
- Email their account specialist at PAS@PartnersBHM.org for additional help or call the Provider Services Line at 1-877-398-4145 for questions other than rates or claims.