Medical Billing Experts and
Specialists in North Carolina
We help NC practices reduce denials, comply with state payer rules, and maintain
steady cash flow with specialty-aligned medical billing.
HIPAA Compliant
NC Medicaid Expertise
98% Clean Claim Rate
Why Medical Billing in North Carolina Requires Specialized Handling
North Carolina has a diverse payer ecosystem with strict documentation rules
and county-based variations in Medicaid programs.
To stay compliant & profitable, NC clinics must navigate
Increasing denials from Healthy Blue, WellCare and AmeriHealth Caritas NC
Medicare claims routed through Palmetto GBA (MAC)
Eligibility issues for high-turnover patient populations
Documentation-heavy requirements for Medicaid Managed Care
Heavy urban–rural payer mix differences (Charlotte vs. rural counties)
Modifier-sensitive edits across commercial payers
End-to-End Billing Solutions
Built for NC Providers
Medical
Billing
Clean claims, faster reimbursements, and billing accuracy.
Medical
Coding
Accurate ICD-10, CPT, and HCPCS coding with specialty-trained coders.
Billing
Audit
Identify hidden revenue leaks instantly
A/R
Follow-Up
Aggressive follow-up on 30/60/90+ day claims to reduce aging AR.
Credentialing &
Enrollment
Fast payer enrollments, CAQH updates, and NPI support.
State Licensing
Support
Hassle-free provider licensing and renewals across multiple states.
Denial
Management
Fix root causes, recover revenue, and prevent future denials.
Platforms, EMRs & Clearinghouses
We Support Across North Carolina
Our team works seamlessly within the systems NC clinics
already use, with no workflow disruption or retraining
required.Our billing framework integrates with nearly every EMR,
PM, and clearinghouse used across the state.
Most widely used in NC
Specialties We Serve Across
North Carolina
Each specialty includes NC-specific coding patterns, modifier logic & payer rules.
North Carolina Billing Expertise
That Others Overlook
Most billing teams rely on generic national workflows.
We use North Carolina–aligned expertise, including
Deep experience with Healthy Blue, WellCare,
AmeriHealth Caritas NC, UnitedHealthcare NC,
Aetna NC, BCBS NC
Understanding of Medicaid Managed Care
documentation requirements
Faster enrollment for NC Medicaid Standard &
Tailored plans
Specialty-aligned coding accuracy for high-
volume NC clinics
Dedicated biller assigned to your NC region
Transparent reporting with denial root-cause
tracking
Your practice receives predictable, stable monthly revenue.
NC Medicaid &
Medicare Requirements
NC Medicaid Standards
Prior authorization is often required for imaging, behavioral health, and chronic care
Tight medical necessity enforcement
Strict visit limits depending on plan
Claim filing deadlines vary by MCO
Managed Care plans require matching clinical notes
Medicare in North Carolina
Handled by Palmetto GBA (MAC)
Common NC Medicare issues
Modifier 25 &
59 scrutiny
Bundling
edits
Medical
necessity audits
We correct these before claim submission.
Common Claim Denials in
North Carolina & Fixes
Denial Code
CO-197
CO-16
CO-109
PR-1
CO-45
Issue
Missing/invalid authorization
Missing info
Not covered
Deductible
Exceeds fee schedule
NC Reason
Common with NC Medicaid MCOs
High in primary care/urgent care
Medicaid Standard vs Tailored mismatch
Medicare Palmetto GBA
Medicaid & BCBS NC frequent
Fix
Submit PA + attach clinical notes
Correct demographics + eligibility
Verify plan details
Upfront collection + Part B verification
Add detailed notes + submit appeal
Major North Carolina
Payers We Work With
Payer Name
Healthy Blue NC
WellCare NC
AmeriHealth Caritas NC
Carolina Complete Health
UnitedHealthcare NC
Aetna NC
Cigna NC
BCBS NC
Humana
Palmetto GBA
Type
Medicaid
Medicaid
Medicaid
Medicaid
Commercial
Commercial
Commercial
Commercial
Medicare
Medicare
Notes
High volume statewide
Strict PA enforcement
Documentation-heavy
PCP-aligned rules
Frequent coding edits
Precert required
Modifier-sensitive
Largest payer in NC
Chronic care-heavy
Edits + NCCI rules
Cities We Serve
in North Carolina
Charlotte
Raleigh
Greensboro
Durham
Fayetteville
Albany
Cary
Wilmington
High Point
Counties We Serve
in North Carolina
Wake
Mecklenburg
Guilford
Forsyth
Durham
Cumberland
Buncombe
Union
Johnston
Cabarrus
New Hanover
Orang Gastone
Key Performance Metrics
for NC Practices
Our billing engine delivers measurable financial outcomes for North
Carolina clinics
98%+ Clean Claim
Rate
smooth payer approvals
30–50% Reduction
in Denials
NC payer alignment
Specialty-Based
Coding Accuracy
lower audit risk
HIPAA-Compliant
Operations
secure & reliable
Real-Time Revenue
Dashboards
complete visibility
Our Billing Workflow
for NC Practices
01
Eligibility Verification
& Medicaid Checks
02
Coding & Charge
Entry
03
Clean Claim
Review
04
Submission to
Clearinghouse
05
A/R Follow-Up
06
Denial
Management
07
Monthly Revenue
Reports
Ready to Strengthen Your Revenue
in North Carolina?
Let our billing specialists clean up your claims, reduce denials, and maximize your reimbursements.
What New York Providers
Say About Us
Dr. Emily S.
Dermatology
“They understand specialty coding better than most in-house teams.”
Laura P.
Urgent Care
“We recovered thousands in lost AR. Reporting is clean, simple, and accurate.”
Dr. Michael R.
Cardiology
“Collections improved within 60 days. Their denial management is the best we’ve seen.”
Dr. Sofia M
Behavioral Health
“Behavioral health denials dropped massively. Their team knows payer rules inside out.”
Dr. Emily S.,
Dermatology
“They understand specialty-specific coding better than most in-house coders.”
Laura P.,
Urgent Care
“We recovered thousands in lost A/R within weeks. Reporting is clean and accurate.”
Dr. Michael R
Cardiology
“Collections increased in the first month. Their denial correction is faster than any team we’ve used.”
FAQ (North Carolina-Specific)
Yes, solo providers, group clinics, outpatient centers, urgent care, behavioural health, paediatrics & more.
Yes, we enroll with Healthy Blue, WellCare, AmeriHealth Caritas, Carolina Complete Health & more.
NC providers typically see a 30–50% reduction in denials within 60–90 days.
Yes, including Standard and Tailored Plans.
Epic, Athena, eCW, NextGen, Kareo, DrChrono, AdvancedMD & others.
Yes, aggressive pursuit at 30, 60 & 90+ days.
10 core specialties (listed above) + custom specialties upon request.
Yes, especially for imaging, behavioural health & chronic care services.
3–5 days for existing-credentialed clinics; 1–3 weeks with credentialing.
Address
4309 Schubert, Colleyville Texas, TX 76034
Phone Number
(737) 787 2147
Business Hours
Monday – Friday: 08.00 – 17.00 Saturday: 09.00 – 12.00
