- +1 (773) 985-1869
- info@stream-rcm.com
- 14430 Ocean Point, El Paso, TX 79938
Stream RCM is a healthcare billing agency that offers various services to clinics, physicians, medical practices, and healthcare providers based in North Carolina. Some of the services include medical billing, coding, claims processing, denial management, A/R follow-up, payment posting, and credentialing. Expansion of the Medicaid program in North Carolina has led to over 650,000 additional eligibles since December 2023.
The biIlling Challenges
The North Carolina practices have their services provided under the expanded Medicaid program together with the Medicare and private insurance programs. In 2025, more than 3 million people received the Medicaid services in the state whereas the Medicaid expansion program included more than 640,000 beneficiaries in its first year. County-level disparities are also important to take into account. For example, Guilford County recorded Medicaid coverage at 32 percent for its residents as opposed to 28 percent in the whole state, thus resulting in high payer verification and reimbursement activities locally.
Statewide Medicaid Coverage
Guilford Medicaid Enrollment
Statewide Expansion Enrollment
Stream RCM is one of the healthcare providers in North Carolina that is able to support over 50 specialties, ensuring that the billing processes can account for the variety of documentation, coding, authorization, charging, and reimbursement needs associated with each. The services can be used in support of primary care, cardiology, orthopedics, gastroenterology, behavioral health, dermatology, pediatrics, internal medicine, urgent care, radiology, oncology, urology, physical therapy, wound care, anesthesia, nephrology, and many more specialties by healthcare providers.
Stream RCM reports a 99 percent clean claim rate, denial reduction of up to 75 percent, 40 to 50 percent higher collections, and 90 percent of claims paid within 30 days. These are company reported metrics.
North Carolina billing requires coordinated eligibility, coding, claims, payment, denial, and A/R workflows. Stream RCM is one of the best medical billing companies in North Carolina connecting these functions to reduce avoidable errors and improve revenue visibility. North Carolina uses a statewide Medicare physician fee schedule locality, simplifying geographic Medicare configuration compared with states using multiple localities.
Patient Information
Insurance EligibilityClinical Coding
Charge Capture
Claim Quality
Electronic Claim
Payment Posting
Denial Resolution
A/R PerformancePatient registration establishes the information used throughout the revenue cycle. We review demographics, insurance information, provider details, and responsible party data before claims move forward. Accurate information helps prevent avoidable eligibility and demographic rejections that can delay reimbursement. This control becomes increasingly important in North Carolina because Medicaid expansion has substantially increased the number of adults entering the coverage system. As of April 2025, over 650,000 North Carolinians have signed up through the expansion initiative. Proper sign-ups lay a strong foundation for undertaking eligibility determination, coding, claim generation, posting of payments, and account follow-up.
Eligibility verification determines whether coverage is active and identifies the payer responsible for the encounter. Billing teams can review plan information, benefits, patient responsibility, authorization requirements, and coverage dates before claims are submitted. North Carolina's Medicaid expansion covers adults ages 19 through 64 who meet applicable income requirements, increasing the importance of correctly identifying newly eligible beneficiaries. County variation further reinforces this need. Mecklenburg reported substantial expansion related coverage gains, while Guilford reported expansion enrollment exceeding the statewide rate. We incorporate coverage review before claim preparation.
Coding of the medical record converts the documentation of procedures and/or diagnosis into codes that will be used for claim submission and processing. In our pre-submission check of coding, we ensure that the coding is accurate, we verify the use of any modifiers required, we verify diagnosis coding relationships, we make sure the right procedures have been coded, and we adhere to specialty specific requirements. Coding errors can lead to denials, under payments, or delayed reimbursement among others. Medicare physician fee schedule in North Carolina is done using a statewide locality and not the Medicare localities that exist in some other states according to counties.
The charge capture links documentation of services performed on patients to the billing charges. There may be problems such as omitted procedures, missing details from the encounter, wrong units or modifiers leading to legitimate charges being left unbilled. Our team audits charge details before claims submission to ensure consistency between documentation and billing details. This is critical in specialties with many procedures, repeat treatments, materials and/or ancillary services. Charge capture helps in creating a better audit trail from encounter, documentation of service, the charge that was sent, the payer's action and the ultimate payment received.
Claims preparation is the process where patient demographic data, insurance data, provider data, codes, modifiers, charges, and documentation come together. We use claim review processes to uncover any data that is either missing or incorrect prior to electronic submission. Our organization boasts a 99 percent rate of clean claims, but the reality is that results depend on payer mix, specialty, documentation quality, coding quality, and workflow of practice. The North Carolina Medicaid world also presents a consideration in that regard due to the managed care plans and categories of coverage.
Electronic submission moves validated claims into the payer adjudication process while allowing billing teams to monitor acceptance, rejection, and payer responses. Our team reports a 98 to 99 percent clean claim rate across its published materials, reflecting slightly different figures appearing on company pages. Electronic workflows allow rejected claims to be identified and corrected earlier than manual processes. For North Carolina providers, timely submission is particularly important when serving growing Medicaid populations following expansion. Better submission controls can reduce avoidable rework and provide earlier visibility into claims requiring correction, documentation, or payer follow up.
Payment posting documents insurance payments, contractual adjustments, patient pay amounts, refund amounts, and account balances post-adjudication. Proper payment posting helps practices identify whether their accounts have been paid or if there is anything more that needs to be done for their payment. According to the reports, 90 percent of all claims are paid in 30 days, but the actual payment time will vary based on payer contracts, claim complexities, documentation, appeals, and patient pay amounts. For practices in North Carolina handling claims for Medicaid, Medicare, and commercial payers, payment posting supplies the necessary financial information.
Denial management needs to deal with both individual denials and the underlying issues. We classify the payers' decisions based on eligibility, authorization, coding, documentation, medical necessity, filing, and other claim problems. The organization has seen a reduction in denials by as much as 75 percent. It is important to note that this is an internal performance measure from the organization as opposed to a certainty for any provider. In North Carolina, denial review could show the source of the problem, whether it is at the time of registration, authorization, coding, claim processing, or payer communication.
Management of accounts receivable places emphasis on prioritization of accounts based on the following criteria; time since billing, payer, account balance, denied accounts, deadlines for filing and collectability of claims. Our team tracks unresolved claims, makes contacts with payers, investigates uncollected accounts and assists in making necessary appeals. The reports issued by our team reveal 40-50 percent improvement in revenue collections and 40-50 percent savings in operations when compared with the company's comparison benchmarks. These statistics have been revealed by the company and should be compared against each medical practice’s starting point.
Internal billing requires practices to maintain employees, training, software, supervision, coverage, compliance knowledge, and payer follow up capacity. Outsourcing can provide a specialized billing team without requiring the practice to build every revenue cycle function internally. Stream RCM provides medical billing and coding in North Carolina and reports 98 percent clean claims, up to 75 percent denial reduction, 40 to 50 percent higher collections, and 40 to 50 percent operational savings.
| Billing Factor | In House Billing | Outsourced Stream RCM |
|---|---|---|
| Staffing | Recruiting, salaries, training, benefits, and absence coverage | Specialized billing personnel and dedicated account support |
| Claims | Performance depends on internal controls and staffing capacity | Company reported clean claim rate of 98 percent |
| Denials | Internal team handles research, correction, and appeals | Structured denial analysis and payer follow up |
| Collections | Results depend on staffing, workflow, and A/R discipline | Company reports collections 40 to 50 percent higher |
| Operating Costs | Technology, personnel, management, and training remain internal | Company reports operational savings of 40 to 50 percent |
We combine core billing functions with coding, A/R, denials, credentialing, reporting, and revenue cycle oversight for healthcare providers.
Prepare, confirm, submit, track, and reconcile claims whereas addressing preventable errors before payer adjudication delays reimbursement.
Evaluate documentation, diagnosis codes, procedure codes, modifiers, and specialty requirements to support accurate compliant payments.
Identify denial causes, correct appropriate claims, prepare supported appeals, and monitor payer responses until resolution of the denial recovery.
Prioritize aging balances, contact payers, investigate unresolved accounts, and maintain accurate visibility into collectible revenue following AR.
Coordinate payer enrollment documentation, application tracking, provider status updates, and renewal requirements to minimize delays.
North Carolina has 100 counties, and Medicaid enrollment varies substantially between urban, suburban, and rural markets. Medicare physician fee scheduling uses one statewide locality for all counties.
More Medicaid enrollees than any other North Carolina county, with expansion adding substantial coverage.
The large metropolitan provider market requires scalable eligibility, claims, coding, and A/R workflows and volumes.
Medicaid covered about 32 percent of residents, above the 28 percent statewide comparison reported locally.
County reporting identified 114,627 Medicaid recipients and 23,230 expansion enrollees during 2025 reporting.
July 2025 Medicaid enrollment reached 76,482, including 16,917 expansion beneficiaries, according to reporting.
March 2025 Medicaid enrollment reached 137,735, creating significant public payer billing activity locally.
FY2025 reporting listed 58,839 active Medicaid recipients and more than 17,917 Medicaid applications processed.
June 2024 Medicaid enrollment reached 58,293, including 11,765 expansion beneficiaries, demonstrating coverage.
June 2024 Medicaid enrollment reached 70,107, including 11,841 expansion beneficiaries, eligibility workflows.
June 2024 Medicaid enrollment reached 42,365, including 7,420 expansion beneficiaries, amid established managed care.
Local Medicaid services support family, adult, and transportation programs, requiring accurate eligibility and coordination.
Local eligibility services cover adult, family, and children's Medicaid, reinforcing the need for coverage verification.
June 2024 Medicaid enrollment reached 10,920, including 2,162 expansion beneficiaries and public payer demand.
June 2024 Medicaid enrollment reached 19,889, including 3,608 expansion beneficiaries, supporting claims.
Medicaid expansion covers adults ages 19 through 64, with local applications managed through eligibility services.
Our medical billing North Carolina reports 99 percent clean claims, up to 75 percent denial reduction, 40 to 50 percent higher collections, and 90 percent paid within 30 days.
Medical billing involves patient registration, eligibility determination, medical coding, charge entry, claim preparation, claim filing, payment processing, denial management, accounts receivable follow-up, and reporting. A synchronized process will help practices handle their claims related to commercial insurance, Medicare, and North Carolina Medicaid.
Yes. Our services cover everything from eligibility, claim filing, coding, payment posting, denial management to A/R processes. The Medicaid Expansion in North Carolina since December 2023 has greatly expanded the population covered and as such, proper payer identification and eligibility confirmation is critical to those involved.
The Medicare physician fee schedule locality for North Carolina includes all the counties of North Carolina. In other words, physicians do not have to deal with several Medicare geographic localities in North Carolina, although proper coding, provider details, claims and relevant fee schedules continue to be very important.
We can work with established EHR, EMR, and practice management systems. Its published materials reference platforms including eClinicalWorks, AdvancedMD, Kareo, athenahealth, NextGen Healthcare, DrChrono, WebPT, and others. Integration depends on available interfaces and individual practice configuration.
The process identifies denial causes, reviews coding and documentation, corrects appropriate claims, prepares supported appeals, and monitors payer responses. Our team reports denial reduction of up to 75 percent. Actual results depend on payer mix, specialty, documentation, coding accuracy, and the practice’s starting performance.
Outsourcing can transfer substantial billing administration to a specialized team while giving providers access to structured claims, denial, A/R, payment, and reporting functions. Our team reports 40 to 50 percent operational savings and higher collections, but actual financial results depend on each practice’s baseline.
Improve billing accuracy, reduce administrative workload, accelerate reimbursement, and gain clearer visibility across your practice revenue cycle.
