Welcome to your daily briefing on healthcare developments in North Carolina. Today we're covering 8 key stories including updates on north carolina healthcare headlines, background & context. Let's dive in.
5 stories
NCIOM has compiled a directory of state and federal health departments and divisions with descriptions of what each entity does.
Understanding which health department or division oversees specific functions helps NC healthcare professionals navigate regulatory requirements and locate the right points of contact.
The North Carolina Department of Health and Human Services (DHHS) is responsible for ensuring the health, safety and well-being of all North Carolinians.
Healthcare professionals in NC should monitor DHHS as the primary state agency shaping policy, funding, and regulatory priorities that directly impact clinical practice and patient care statewide.
The North Carolina Medical Board was established to properly regulate the practice of medicine and surgery for the benefit and protection of the people of North Carolina.
Understanding the board's regulatory role helps NC healthcare professionals stay aligned with the standards that govern their practice and protect their patients.
The Transformed Medicaid Statistical Information System (T-MSIS) aims to be the most trusted resource of comprehensive, quality Medicaid and CHIP data for policy formulation, implementation and oversight that improves public health outcomes.
North Carolina healthcare professionals rely on robust Medicaid and CHIP data to inform clinical decisions, reimbursement strategies, and population health initiatives that directly serve NC patients.
NCDHHS is launching a new electronic health records system for state-operated health facilities, with a ceremony marking this advancement in patient communication and care.
Healthcare professionals in NC should monitor this system rollout as it may affect referral workflows, care coordination, and data exchange with state facilities.
Reach healthcare professionals
3 stories
Across most payors, the top-five denial reasons account for over 80% of prior-auth rejections: missing clinical documentation, wrong CPT/HCPCS code, service not in benefit plan, step-therapy not completed, and ordering provider not on the patient's plan. The same five repeat across plans because they are the easiest to deny on automation.
Practices that build a five-line pre-submission checklist around these reasons typically cut prior-auth denials by 40-60% within a quarter. The fix is process, not appeals capacity.
A vendor is a business associate if they create, receive, maintain, or transmit PHI on behalf of the covered entity. They are NOT a business associate just because they happen to be in a building with PHI or could conceivably access it. The functional test matters, not the proximity test.
Forcing BAA execution on vendors who do not meet the functional test creates contractual bloat and weakens the negotiating position with vendors who actually do. Failing to execute BAAs with true business associates exposes the covered entity to OCR enforcement.
Covered entities must annually recertify their 340B eligibility through HRSA. Missing the recertification window pushes the entity to inactive status, which means immediate loss of 340B pricing and potentially diversion violations on previously dispensed drugs. Reinstatement requires a new application.
The discount value of 340B pricing for a covered entity often exceeds six figures annually. Letting the recertification lapse for paperwork reasons is one of the most expensive administrative errors in the regulation.
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