Issued: October 31, 2025
Earlier this year, the North Carolina Department of Health and Human Services (NCDHHS) requested additional funding from the General Assembly to fully support the state’s Medicaid rebase. The final appropriation from the General Assembly was less than requested, resulting in a funding shortfall.
To address this shortfall, NCDHHS developed a plan that requires provider rate reductions and other cost-saving measures. These rate reductions took effect Oct. 1, 2025. However, all four LME/MCO delayed implementation until Nov. 1, 2025, to help minimize provider disruption and allow time for continued discussions about funding at the state level.
With no changes to the current funding structure at this time, the rate adjustments will move forward as directed by NCDHHS, effective Nov. 1, 2025.
What is happening?
After delaying the NCDHHS October rate deductions, Partners will implement the cuts on Nov. 1, 2025.
- The new reduced rates are effective Oct. 1, 2025. Depending on the service category, rates have been reduced by 3%, 8% or 10%. New provider rates can be found here.
- Rate reductions have also been applied to both provider and member enhanced rates where applicable.
Partners will recoup the claims paid at the former (higher) rate as soon as possible after Nov. 1, 2025. To ease the administrative and financial burden on providers, Partners will stagger reprocessing of claims for the month of October 2025 as follows:
- Any adjudicated claims with a date of service Oct. 1-Oct. 14, 2025, with a claims process date prior to Nov. 1, 2025, will be re-adjudicated the week of Nov. 1, 2025.
- Any adjudicated claims with a date of service Oct. 15-Oct. 31, 2025, with a claims process date prior to Nov. 1, 2025, will be re-adjudicated the week of Nov. 15, 2025.
- All claims with a service date of Oct. 1-Oct. 31, 2025, that are submitted and/or processed after Nov. 1, 2025, will process normally against the new rate schedules.
- If an affected claim includes claims lines that are outside of the affected time frame, the entire claim will be re-adjudicated.
All claims with a service date of Nov. 1, 2025, and later will be processed normally according to the new rate schedules.
The updated fee schedules can be viewed on the Partners knowledge base at the link below:
https://legacy.providers.partnersbhm.org/claims-information/
Partners recognizes that these reductions are significant and will have serious consequences for North Carolina Medicaid providers. We remain committed to working alongside our providers and community partners to preserve the strength and stability of services for the members and communities we serve.
What do providers need to do?
No action is needed by Partners’ providers. However, providers should prepare for adjustments in claims and reimbursement effective Nov. 1, 2025, and monitor communications from Partners closely for further updates.
Who can providers contact if they have questions?
Questions related to claims reprocessing can be sent to claimsdepartment@partnersbhm.org.