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The Vermont All-Payer ACO Model, a first-of-its-kind CMS agreement running Medicare, Medicaid, and commercial payers through one accountable care structure, began in 2017 and concluded on December 31, 2025. OneCare Vermont, the ACO built to administer it, wound down operations at the same time. This wasn't a minor program tweak. It was the end of the specific payment mechanism most Vermont providers had billed under for close to a decade.
OneCare issued its final fixed payment to providers on December 26, 2025, with reconciling activity continuing into April 2026. Since January 1, 2026, Vermont providers have been submitting claims for fee-for-service payment instead. For anyone who built their billing operation around OneCare's value-based payment cycle, the claim-by-claim fee-for-service world is a genuinely different operational rhythm, not just a rate change.
Vermont is one of the early states participating in the AHEAD model, States Advancing All-Payer Health Equity Approaches and Development, which holds participating states accountable for overall healthcare spending and population health outcomes. It's a different framework than OneCare's, still taking shape through 2026, and worth tracking closely if your practice bills a meaningful share of Medicare or Medicaid volume.
The University of Vermont Health Network, which became OneCare's parent company in 2021, remains the dominant hospital system in the state. Dartmouth Health, based just across the New Hampshire border, also carries significant weight for Vermont patients in the eastern part of the state, and was a founding partner in building OneCare in the first place.
Claims submission rebuilt for Vermont's return to fee-for-service billing after the end of the OneCare all-payer model.
Learn MoreFull-cycle RCM that separates outstanding OneCare reconciliation activity from current fee-for-service claims during the transition.
Learn MoreProvider enrollment across Blue Cross Blue Shield of Vermont, MVP Health Care, and the hospital-affiliated networks tied to UVM Health Network.
Learn MoreA free audit that checks specifically for billing workflows still configured around the ended OneCare payment model.
Learn MoreFront-desk and administrative support that scales with a growing Vermont practice without new office overhead.
Learn MoreBenchmarks your claims data against current Vermont fee-for-service denial patterns during the post-OneCare transition.
Learn MoreLocal visibility support built for a small, close-knit provider market where patients often travel across county lines for specialty care.
Learn More| Vermont Regulation | The Generic Billing Trap | The MD Revenue Group Approach |
|---|---|---|
| OneCare ACO Wind Down | Allowing legacy value-based payment audits to mix with active claim records, confusing write-offs. | We separate old value-based reconciliation files from current fee-for-service collections. |
| VT Medicaid FFS Shift | Failing to submit direct CPT codes via the Green Mountain Care portal after OneCare's closure. | We configure clearinghouses to submit individual FFS codes directly to Green Mountain Care. |
| GMCB Hospital Audits | Failing to update practice fee structures and missing approved commercial contract rate limits. | We review contract schedules with Blue Cross VT and MVP Health to capture GMCB-approved updates. |
| Wellpoint Federal J-K | Failing to update clearinghouse credentials or verify EDI submitter profiles after the NGS MAC rename. | We audit clearinghouse portfolios to ensure active linkages with Wellpoint Federal. |
We audit your last 90 days of claims for FFS code alignment and legacy OneCare ACO reconciliation items.
A written plan targeting the specific leakage points the audit found, not a generic onboarding checklist.
Your existing vendor keeps running while we credential and build claim rules in parallel, proven on real claims first.
Real-time reporting on collections, denials, and A/R velocity, so you see the recovery as it happens, not at quarter-end.
Our local Vermont billing experts successfully completed legacy OneCare value-based reconciliation files and transitioned billing workflows to submit individual FFS codes directly to Green Mountain Care.
See What We Can Recover For YouOneCare Vermont concluded its All-Payer ACO Model at the end of 2025. Final reconciliation activity ran through April 2026. Billing systems must separate historical reconciliation lines from current claims to ensure proper closeouts.
Following the end of OneCare, Vermont Medicaid providers returned to a standard fee-for-service payment model. Revenue cycles must transition from fixed value-based disbursements back to individual CPT claim submissions.
The Green Mountain Care Board regulates hospital budgets and rate increases. State cost limits affect commercial contract negotiations downstream, meaning practice fee schedules must be reviewed to capture allowed increases.
We check specifically for Green Mountain Care fee-for-service transitions, OneCare legacy reconciliation audits, and Wellpoint Federal Jurisdiction K configurations.
