MedStats Billing delivers end-to-end revenue cycle management built for North Carolina practices. We hold insurers to the 30-day pay-or-notify rule in G.S. 58-3-225, pursue the 18% statutory interest on claims paid late, work the two-year underpayment window most practices never open, and bill every NC Medicaid Managed Care standard plan, Tailored Plan and the Children and Families Specialty Plan.
North Carolina attaches the highest statutory interest rate of any state MedStats serves to claims that miss the clock, and it gives providers a two-year window to go back and collect underpayments with that interest attached. The same statute limits how and when a carrier can take money back. Medicaid moved to managed care with standard plans, four Behavioral Health and IDD Tailored Plans and a specialty plan for foster care, each with its own routing. And work injury bills die at 75 days. North Carolina rewards practices that work their aged AR and punishes the ones that file late.
North Carolina Billing Specializations:
Prompt Claim Payment (G.S. 58-3-225) — An insurer must pay a claim or send the claimant a notice within 30 calendar days of receipt, and where a claim is denied or contested in part it must still pay the undisputed portion inside those 30 days. After requested information arrives, the insurer has a fresh 30 days to pay or deny.
18% Statutory Interest — Claims not paid within the statutory period carry interest at an annual rate of 18%, running from the day after payment was due. At that rate aged AR is worth auditing line by line, and we do.
The Two-Year Underpayment Window — Providers may recover underpayments and nonpayments by demand, with applicable interest, within two years of the original claim adjudication. Most practices never look back past 90 days. The statute gives them eight times that.
Overpayment Recovery Rules — A carrier must give at least 30 calendar days’ written notice, with the specific claim and the specific reason, before recovering an overpayment or offsetting future payments, and recovery is limited to two years after the original payment absent a reasonable belief of fraud. We check every offset against both conditions.
Claim Filing Deadlines — Claims are due 180 days after the date of service or discharge, and where it was not reasonably possible to file in time the insurer must accept the claim up to one year beyond that date if it was submitted as soon as possible. Electronic claims are presumed received on the day of transmission; mailed claims five business days after posting.
NC Medicaid Managed Care Standard Plans — AmeriHealth Caritas North Carolina, Carolina Complete Health, Healthy Blue, UnitedHealthcare Community Plan and WellCare of North Carolina, alongside NC Medicaid Direct for members who remain fee-for-service.
Tailored Plans & the Specialty Plan — Behavioral Health and Intellectual/Developmental Disability Tailored Plans launched 1 July 2024 through Alliance Health, Partners Health Management, Trillium Health Resources and Vaya Health, and the Children and Families Specialty Plan covers foster care and adoptive families statewide. Sending a claim to the wrong entity is the most common Medicaid denial in the state.
Workers’ Compensation Billing (11 NCAC 23J; G.S. 97-26) — Bills must be submitted within 75 days of the service, or within 30 days after the end of the month for ongoing treatment, and the payer must pay or send written objections within 30 days of receipt. Professional fees follow the current year’s North Carolina Medicare Part B schedule as adopted by the Industrial Commission.
Fee Dispute Resolution — Medical provider fee disputes run through the Industrial Commission’s procedure under G.S. 97-26(i) on Forms 26I and 33I. We prepare and file them rather than writing off the reduction.
Major North Carolina Payers — Blue Cross and Blue Shield of North Carolina, Aetna, Cigna, UnitedHealthcare, Humana, MedCost and the State Health Plan denial workflows.
Built to bring clarity, control and consistency to your North Carolina practice’s revenue cycle.
MedStats Billing manages the complete revenue cycle for North Carolina providers — from NCTracks enrollment and health plan credentialing, through coding, claim scrubbing and submission, to denial resolution, 18% interest recovery, offset defence and medical fee disputes before the Industrial Commission.
Certified CPT, ICD-10-CM, and HCPCS coding with pre-submission claim scrubbing built around each payer's edits, so claims pay on the first pass. We manage charge entry, claim submission, payment posting, and insurance follow-up.
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Enrollment with Medicaid managed care plans, Medicare via PECOS, and commercial payers — plus CAQH maintenance and re-credentialing deadline tracking, so your providers stay in-network and billable without gaps.
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Coverage confirmed before the visit — active policy status, deductibles, co-pays, plan type, and prior authorization requirements — so front-end denials are caught while there is still time to fix them.
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Aged claims worked by payer and denial reason, with appeals filed inside each plan's window. We monitor outstanding balances, manage rejections, and drive down days in A/R to protect cash flow.
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A detailed review of coding accuracy, documentation standards, and denial patterns that identifies revenue leakage and compliance exposure — before a payer audit finds it for you.
Explore serviceLocal SEO, Google Business Profile optimization, and reputation management built for medical practices — helping the patients already searching for your specialty find you first.
Explore serviceNorth Carolina practices lose more revenue to unworked aged AR and unchallenged offsets than to coding, and the statute is unusually generous to providers who actually use it. These are the four we eliminate:
Claims not paid inside the statutory period carry interest at an annual rate of 18% from the day after payment was due. That is the highest rate in any state we serve, and practices routinely accept the principal alone and close the account.
Providers may demand recovery of underpayments and nonpayments, with applicable interest, for two years after the original claim adjudication. Practices that stop reviewing at 90 or 120 days write off nearly two years of recoverable money every year.
Before recovering an overpayment or offsetting future payments, a carrier must give at least 30 calendar days’ written notice identifying the specific claim and the specific reason, and recovery is capped at two years after the original payment absent a reasonable belief of fraud. Offsets that fail either test should be challenged, not absorbed.
A provider of medical compensation must submit its bill within 75 days of the service, or within 30 days after the end of the month where treatment continues, and the payer then has 30 days to pay or object in writing. Bills that arrive late are the cleanest denial a work comp payer ever gets.
An insurer must pay a claim or send the claimant notice within 30 calendar days after receipt, must pay the undisputed portion of a partly contested claim inside the same 30 days, and must pay or deny within 30 days of receiving any additional information it requested. Claims paid late carry interest at an annual rate of 18% from the day after payment was due.
North Carolina runs a symmetrical two-year clock. Providers may pursue underpayments and nonpayments with interest for two years after the original adjudication, and insurers may recover overpayments or offset future payments for two years after payment, but only after at least 30 days’ written notice identifying the claim and the reason.
Professional services are reimbursed from the current year’s North Carolina Medicare Part B fee schedule as adopted by the Industrial Commission, with hospital inpatient care on a DRG methodology and implants capped at invoice cost plus a fixed percentage. Bills are due within 75 days, payers respond within 30, and disputes run through the Commission’s fee dispute procedure on Forms 26I and 33I.
Standard plans are AmeriHealth Caritas North Carolina, Carolina Complete Health, Healthy Blue, UnitedHealthcare Community Plan and WellCare of North Carolina. Behavioral Health and I/DD Tailored Plans launched 1 July 2024 through Alliance Health, Partners Health Management, Trillium Health Resources and Vaya Health, the Children and Families Specialty Plan serves foster care and adoptive families, and NC Medicaid Direct remains for fee-for-service members.
MedStats Billing provides tailored billing solutions for a wide range of medical specialties, ensuring accurate coding, fewer denials, and faster reimbursementsto maximizes your revenue potential.
MedStats Billing handles NCTracks enrollment, standard plan and Tailored Plan credentialing, 30-day clock tracking, interest and offset recovery and Industrial Commission fee disputes across North Carolina, giving practices end-to-end RCM support in a state whose statute pays providers to be persistent.
Claims are scrubbed against standard plan, Tailored Plan and commercial payer edits before submission to drive clean first-pass reimbursement.
We work the full two-year underpayment window the statute allows, with interest, instead of closing accounts at 90 or 120 days.
We track the 30-day clock on every claim and pursue the 18% statutory interest North Carolina attaches to late payment, rather than accepting the principal and moving on.
Working knowledge of Blue Cross and Blue Shield of North Carolina, Aetna, Cigna, UnitedHealthcare, Humana, MedCost, the State Health Plan and every NC Medicaid Managed Care plan.
Whether you practise in Charlotte, Raleigh, Greensboro, Durham or Asheville, our workflows adjust seamlessly as your group grows across the state.
HIPAA-compliant data handling and controlled access protect patient health information and billing records at every stage.
We integrate smoothly with widely used EHR platforms to ensure accurate data flow from documentation to claim submission. This reduces manual errors, speeds processing, and supports cleaner reimbursements.
We work alongside leading systems including:
Schedule a complimentary billing assessment with MedStats Billing to uncover hidden revenue loss, reopen the underpayments still recoverable inside the two-year window, and quantify the 18% statutory interest your practice is owed on late-paid claims.
Under G.S. 58-3-225 an insurer must either pay the claim or send the claimant a notice within 30 calendar days after receipt. Where a claim is denied or contested in part, the undisputed portion must still be paid inside those 30 days. Once the insurer receives additional information it requested, it has 30 days from that point to pay or deny. Claims paid outside the statutory period carry interest at an annual rate of 18%.
Two years from the date of the original claim adjudication. Providers may recover underpayments or nonpayments by making demands for refunds, and those recoveries may include the applicable statutory interest. The limit does not apply where the provider received payment for the same service from a government payor. Practices that stop reviewing aged AR at 90 days leave most of that window unused.
An insurer must give the provider or facility at least 30 calendar days’ written notice before seeking an overpayment recovery or offsetting future payments, and that notice must include adequate specific information to identify the claim and the specific reason for the recovery. Recovery or offset must occur within two years after the original claim payment unless the insurer has a reasonable belief of fraud or other intentional misconduct.
Claims are generally due within 180 days after the date of service or discharge. Unless the insurer and claimant agree otherwise, a claim must still be accepted up to one year beyond that date where it was not reasonably possible to submit it on time and it was filed as soon as possible thereafter. Electronic claims are presumed received on the day of transmission, and mailed claims five business days after posting.
Standard plans are AmeriHealth Caritas North Carolina, Carolina Complete Health, Healthy Blue, UnitedHealthcare Community Plan and WellCare of North Carolina. Members with significant behavioural health or I/DD needs are served by Tailored Plans through Alliance Health, Partners Health Management, Trillium Health Resources and Vaya Health, the Children and Families Specialty Plan covers foster care and adoptive families, and NC Medicaid Direct remains for fee-for-service members.
A provider of medical compensation must submit its bill within 75 days of rendering the service, or within 30 days after the end of the month during which multiple treatments were provided where treatment continues. Where liability was initially denied and later admitted or determined, the clock runs from notice of that determination. The payer must pay the bill or send written objections within 30 days of receipt, and must pay the uncontested portion of a partly disputed bill.
We serve practices and healthcare facilities statewide, including Charlotte, Raleigh, Greensboro, Durham, Winston-Salem, Fayetteville, Cary, Wilmington, High Point, Asheville, Concord, Greenville, Gastonia and Chapel Hill.
