Getting Started with Carolina Complete Health

This guide provides need-to-know information regarding the provider portal, securing prior authorizations, important phone numbers, and more!

Known Issues Tracker

This document provides timely information related to known issues impacting providers. This will be updated weekly on Thursdays. 

Provider Announcements

DURHAM, N.C. (March 1, 2023) – Carolina Complete Health Network (CCHN) announced the appointment of Kelly Phillips as its President. Phillips has served as the organization’s Vice President of Operations and Finance since 2020.  CCHN is part owner of the only Provider Led Entity in North Carolina’s Medicaid program, established in 2016 to provide network services for Carolina Complete Health, serving over 220,000 Medicaid members in North Carolina.

Phillips brings extensive experience in business strategy, operations, and finance within the health care sector. She has developed innovative solutions to support providers in national and regional health systems and individual practices to meet the physical and behavioral needs of complex populations.

“We are thrilled to have Kelly as President of Carolina Complete Health Network to support the mission of provider-led health care in North Carolina,” said Stephen Keene, general counsel for CCHN. “Kelly is a strong leader with the vision to expand, support, and grow the first-of-its-kind partnership to transform health.”

Previously, Phillips served in executive and leadership roles at Community Based Care and Alliance Behavioral Health.  She holds an MBA from the University of Missouri - Kansas City and a BBA in Accounting from the University of Iowa.  Phillips also serves on the Board of The Disabled Inventors Foundation.

Rate Increase for Pregnancy Risk Screening (PRS) Form.

To promote the early detection of pregnancy, effective 1/1/23 Carolina Complete Health (CCH) increased the rate for the pregnancy risk screening (PRS) tool from $50 to $100. In accordance with NC DHHS Clinical Coverage Policy 1E-6, providers shall bill the HCPCS code S0280 after the PRS screening tool has been completed. CCH providers can complete the PRS using the forms available on the Pregnancy Medical Home website and fax to CCH Care Management: 833-417-0446. Providers may also complete the PRS on the CCH Secure Provider Portal. Once in the member’s health record, view the Assessments tab on the left, and complete the notice of pregnancy (NOP).

The PRS tool is used to notify Carolina Complete Health of the member’s pregnancy and to identify women in need of pregnancy care management services. Providers can also securely send the PRS to the Local Health Department (LHD) as a referral into the Care Management for High Risk Pregnancy (CMHRP) program.

Additionally, CCH reimburses for the postpartum visit using HCPCS code S0281 in accordance with guidelines from NC DHHS Clinical Coverage Policy 1E-6. The current fee schedule rate for this is $150 for physicians and $220 for LHDs. For additional information and resources, see our Maternal Health Tip Sheet (PDF) and Provider Guide for Pregnant Members (PDF)

Carolina Complete Health members age 5 years and older can receive a $75 My Health Pays® reward when they receive a COVID-19 vaccination.

  • Carolina Complete Health will reward the first 35,000 members who receive a first, second, or booster COVID-19 vaccination starting November 15, 2021 through June 30, 2023. There is a limit of one $75 reward per member. Members must be enrolled with Carolina Complete Health at the time of vaccination.
  • The $75 reward will be loaded on the My Health Pays® Visa® Prepaid Card.  Every Carolina Complete Health member receives a My Health Pays® Visa® Prepaid Card within two weeks of enrollment. 
  • To learn more about this incentive, see the Vaccine Incentive section of the Member Coronavirus Information page.