Why are Medicare and Medicaid shown separately instead of combined?

They come from two different CMS data sources with no shared claim identifier, so they can't be reconciled into one number without double-counting or guessing. Every table and chart on this page keeps them fully separate.

Why is there no private/commercial revenue figure?

Private and commercial payer data comes from Transparency in Coverage files, which only publish negotiated rates — not claims or utilization volume. Without a volume figure, no revenue number can be computed for any provider from that data.

What does "Rank" mean in the Competitive Analysis & Benchmarks tables?

For a given CPT/HCPCS code, it's this provider's position by claims volume among all providers billing that same code at that geography level (State, National, or North Carolina for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to North Carolina only?

Medicaid is administered per-state with no single national fee schedule, so a state or national comparison the way Medicare has one isn't available. North Carolina (this provider's own state) is the only grouping that's conceptually meaningful.

Why are the numbers rounded to the nearest 10?

To avoid implying more precision than the underlying data supports at a single-provider level. Ratios are kept precise since they're a relative comparison, not a volume or dollar figure.

How current is this data?

The Medicare and Medicaid tables are both single current snapshots, not refreshed on a recurring schedule yet.

A Caring Heart Case Management, Inc. (NPI 1447300058)

Field	Value
Entity Type	Organization
Organization	A Caring Heart Case Management, Inc.
Address	1901 Tarboro St Sw Ste 102
City	Wilson
State	NC
ZIP	27893
Taxonomy	Developmentally Disabled Services Day Training Agency
NPI Enumerated	January 12, 2007

Payer Source	Total Paid
Medicaid	$127.5M
Medicare	$0

Key Findings

This entity is effectively single-payer in its public-pay mix: there is no Medicare billing on file and all reported government revenue is Medicaid-focused, with Total Medicaid revenue of $127.5M. The absence of Medicare activity suggests operations are concentrated on waiver-funded developmental-disability services rather than older-adult or acute-care Medicare lines.

Revenue is highly concentrated in a small set of habilitation/day-habilitation codes: the top three Medicaid codes (T2013, T2021, T2012) together account for 76.5% of the provider's Medicaid revenue. Individually those codes generate $37.5M (T2013, 29.4%), $34.8M (T2021, 27.3%), and $25.2M (T2012, 19.7%) of the $127.5M total, indicating a heavy dependence on a narrow set of waiver services.

The code mix (T2013 – habilitation per hour; T2021 – day habilitation per 15 minutes; T2012 – habilitation per diem) indicates the provider functions primarily as a day habilitation and educational services operator under developmental-disability waivers. High volumes in per-hour, per-15-minute, and per-diem habilitation codes point to a programmatic emphasis on structured day services and habilitation training rather than discrete medical procedures or outpatient therapy.

Operational scale is substantial for these program lines: T2013 shows 250.1K claims, T2021 shows 221.7K claims, and T2012 shows 133.9K claims, with average paid/claim of $150, $157, and $188 respectively. Those claim counts and mid-hundreds of dollars per claim demonstrate both high throughput and meaningful per-unit reimbursement for core habilitation services.

Competitive standing in-state is strong and concentrated: the provider ranks as a top statewide participant for its primary codes—T2021 ranks #4 of 199 providers (98th percentile, labeled an "extreme outlier"), T2012 ranks #5 of 110 (96th percentile, "notably above typical"), and T2013 ranks #9 of 185 (96th percentile, "notably above typical"). These ranks indicate this firm is a major player in North Carolina for day habilitation and related waiver services.

Secondary service lines supplement the core habilitation business but are much smaller by revenue. H2016 and H2015 (comprehensive community support services) together contribute $9.5M (7.5%) and $5.4M (4.2%) respectively; H2016 ranks at about the 70th percentile (typical volume) while H2015 ranks at the 96th percentile (notably above typical), suggesting selective strength in certain community-support offerings.

The provider demonstrates both depth and concentration in waiver services that are sensitive to policy or rate changes: with roughly three codes driving the majority of Medicaid revenue, any material reimbursement or eligibility shifts for T2013, T2021, or T2012 could meaningfully affect overall revenue. This concentration also frames negotiating leverage and contracting risk with managed Medicaid plans and state agencies.

The organization has long-standing presence in the market: its NPI was enumerated on 2007-01-12 (~19 years ago), indicating nearly two decades of operation under this billing identity and time to scale the high claim volumes observed in core habilitation lines.

Medicaid: Complete Services Breakdown

Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.

13 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T2013	Habilitation, educational, waiver; per hour	250,120	$150	$37.5M
T2021	Day habilitation, waiver; per 15 minutes	221,750	$160	$34.8M
T2012	Habilitation, educational; waiver, per diem	133,860	$190	$25.2M
H2016	Comprehensive community support services, per diem	48,220	$200	$9.5M
T2020	Day habilitation, waiver; per diem	52,010	$170	$9M
H2015	Comprehensive community support services, per 15 minutes	73,100	$70	$5.4M
T2016	Habilitation, residential, waiver; per diem	20,700	$170	$3.4M
S5150	Unskilled respite care, not hospice; per 15 minutes	29,160	$70	$2.1M
H0045	Respite care services, not in the home, per diem	3,680	$90	$345.6K
H2025	Ongoing support to maintain employment, per 15 minutes	840	$170	$145.3K

Showing 1–10 of 13

Medicaid: Competitive Analysis & Benchmarks

How this provider's Medicaid billing volume and revenue compare to other North Carolina providers billing the same CPT/HCPCS codes.

Claims Volume vs. North Carolina Distribution

A Caring Heart Case Management, Inc. — 4 of 13 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — North Carolina

Full comparison — all codes billed, vs. North Carolina median

13 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T2013	Habilitation, educational, waiver; per hour	9	190	29,090	$150	$9.1M
H2016	Comprehensive community support services, per diem	20	70	28,040	$220	$8.2M
T2020	Day habilitation, waiver; per diem	14	50	22,570	$180	$6.2M
T2012	Habilitation, educational; waiver, per diem	5	110	21,340	$180	$6.1M
T2021	Day habilitation, waiver; per 15 minutes	4	200	25,740	$130	$4.6M
H2015	Comprehensive community support services, per 15 minutes	10	250	10,060	$130	$2.4M
T2016	Habilitation, residential, waiver; per diem	11	90	5,520	$190	$1.6M
H2025	Ongoing support to maintain employment, per 15 minutes	50	60	6,380	$120	$1.3M
H0045	Respite care services, not in the home, per diem	44	80	4,450	$100	$993.7K
S5150	Unskilled respite care, not hospice; per 15 minutes	20	170	4,310	$80	$958.4K

Showing 1–10 of 13

Nearby Providers

Other providers in the same ZIP code as A Caring Heart Case Management, Inc., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Stepping Stones Community Resources, Incorporated	NC	Community/Behavioral Health Agency	$0	$38.2M
Eastern Carolina Pediatrics PA	NC	Pediatrics Physician	$0	$24.6M
Phillips Home Health Care	NC	Home Health Agency	$0	$18M
Bridges Of Hope Inc	NC	Multi-Specialty Clinic/Center	$0	$18M
Interim Healthcare - Morris Group, Inc.	NC	Home Health Agency	$0	$14.8M
Phillips Home Health Care Agency	NC	Home Health Agency	$0	$13.9M
Wilson House LLC	NC	Adult Care Home Facility	$0	$11.7M
Dlp Wilson Medical Center LLC	NC	General Acute Care Hospital	$0	$11.5M
Frederick Myles	NC	Home Health Aide	$0	$9.2M
Polley Clinic Of Dermatology & Dermatologic Surgery	NC	Dermatopathology Physician	$0	$9.1M

A Caring Heart Case Management, Inc. — Billing Profile & Reimbursement Data

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A Caring Heart Case Management, Inc. — Billing Profile & Reimbursement Data

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Key Findings

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References