We Want to Hear From You!

As the only provider-led plan in North Carolina Medicaid Managed Care, Carolina Complete Health is committed to providing the best experience possible for our providers. In order to better serve you, we need your feedback! Please take a moment and tell us how we are doing.


Known Issues Tracker

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


Provider Announcements

  • Carolina Complete Health has attested to the use of the following policies:
    • NC state policy 11B-2 for Heart (Cardiac) Transplantation
    • More specific guidance on genetic testing has been adopted for several areas of genetic evaluation; please see the following for current guidance. We anticipate further guidance on several other genetic topics in the coming months.
      • Adoption of the following Genetic Testing Clinical Coverage Policies (CP.MP.227, CP.MP.217, CP.MP.218, CP.MP.219, CP.MP.220, CP.MP.224, CP.MP. 226, CP.MP.228, CP.MP.229, CP.MP.230)
  • Carolina Complete Health has retired the following policies:
    • CP.MP.96: Ambulatory EEG
    • CP.MP.149: Testing for Rupture of Fetal Membranes
    • CP.MP.89: Genetic and Pharmacogenetic Testing
    • CP.MP.84: Cell-Free Fetal DNA
    • NC.CP.MP.138: Pediatric Heart Transplant (now using NC state policy 11B-2 Heart (Cardiac Transplantation for Adults and Pediatric patients)

The North Carolina Division of Mental Health, Developmental Disabilities and Substance Abuse Services and the Department of Information Technology will be updating the IRIS system on May 25th.  IRIS will be unavailable for all users beginning Wednesday, May 25th beginning at 7:00 a.m. and is expected to be available at 8:00 a.m. on Wednesday, May 25th.    

 

Since IRIS reports are due within 72 clock hours from the time that the provider learns of an incident,  providers may obtain a hard copy of the report from the IRIS  website (https://iris.dhhs.state.nc.us/) before Wednesday morning or print forms from the DHHS website at https://www.ncdhhs.gov/document/incident-response-improvement-system-iris-forms.   Reports can be submitted to Carolina Complete Health fax at 833-318-7255 and to DMH/DD/SAS Customer Service and Community Rights Team via fax at 919-733-4962 within specified timeframes and procedures.  Providers will still need to enter the report into IRIS once the system is available.   Reports to be filed with DHSR Healthcare Personnel Registry should be faxed to HCPR within specified timeframes at 919-733-3207.  Reports regarding Deaths (suicide, homicide/violence, accident, or restraint) in a licensed facility should be reported to DHSR Complaint Intake Unit via fax at 919-715-7724. 

Please be advised that codes 80050, 83718, 87633, 87636, 87637, 87798, & 87811 have been added to the Physician’s Office Lab Testing policy (NC.CC.PP.055) with an effective date of 04/19/2022. See the policy for the full list of codes specific to laboratory testing that are included for coverage in standard office settings.

Update from NC DHHS:

Medicaid postpartum health care coverage will be extended from 60 days to 12 months for eligible beneficiaries in North Carolina beginning April 1, 2022. The benefit will provide 12 months of continuous postpartum coverage to eligible beneficiaries who are currently pregnant or gave birth between Feb. 1, 2022, and March 31, 2022.

IMPORTANT: To get postpartum coverage for 12 months, the beneficiary’s caseworker at their local Department of Social Services (DSS) must be notified:

  • when the beneficiary becomes pregnant 
  • if the due date changes
  • when the pregnancy ends

For more information, provider and beneficiary fact sheets, visit NC DHHS


Getting Started with Carolina Complete Health

Carolina Complete Health Quick Reference Guide Form (PDF)

To join our provider-led network and be a part of Carolina Complete Health Network, please complete our contract request form, call Network Relations at 1-833-552-3876, or email us at NetworkRelations@CCH-Network.com to request a participating provider agreement.

Join the CCHN Provider Engagement team on a New Provider Orientation. For instructions on how to attend, please visit our education and training site. 

New Provider Orientations will cover:

  • Carolina Complete Health overview
  • Provider Engagement and Provider Relations Support
  • Accessing the public website and secured web portal
  • Verification of Eligibility and Carolina Complete Health benefits
  • Prior Authorizations
  • Claims and billing
  • Fraud, Waste & Abuse
  • Cultural Competency

Registration is free and easy! Use the Log In button in the upper right hand corner of this webpage

  • Click create account to register​
  • Follow the prompts – once verified you will receive an email saying that you are ready to log in​
  • From there you'll navigate back to the portal and log in

Using the Secure Provider Portal (PDF), providers will be able to: 

  • Easily check patient eligibility
  • View, manage, and download your patient list​
  • View, and submit claims​
  • View and submit service authorizations​
  • Communicate with us through secure messaging​
  • Maintain multiple providers on one account​
  • Control website access for your office​
  • View historical patient health records​
  • Submit assessments to provide better patient care​
  • Update provider demographic data

Claims may be submitted in 3 ways:​

  1. The Secure Provider Portal - Available 90 days before go-live. Use the login button located on the upper right hand corner of this page​
  2. Electronic Clearinghouse​
    Three clearinghouses for Electronic Data Interchange (EDI) submission: Availity, Change Healthcare (formerly Emdeon), and Ability.  As long as the provider’s clearinghouse has a connection to one of the previously mentioned clearinghouses, then the claim can be passed on to Carolina Complete Health. Carolina Complete Health's Medical Payer ID is 68069
  3. Mail
    Carolina Complete Health
    Attn: Claims​
    PO Box 8040 ​
    Farmington MO 63640-8040

The timely filing deadline for initial claims is 180 calendar days from the Date of Service, or in the case of a health care provider facility, within one hundred eighty days after the date of the member’s discharge from the facility.​

What is a paid claim?

  • Paid in Full - The claim has been adjudicated, processed and reimbursed in accordance and with the executed provider contract on file including the coordination of benefits, as applicable per claim.

Please visit the Claims and Billing section of our Provider Resources to view our billing manual.

Setting up EFT and ERA:

Carolina Complete Health offers Payspan, a free solution that helps Providers transition into electronic payments and automatic reconciliation. Payspan will be available 30 days before implementation

 

Access the Pre-Auth Check Tool to determine whether a prior authorization is required

Emergency services, family planning, post stabilization services, and table top x-rays do not require prior authorization. 

Prior authorizations can be submitted in 3 ways: 

  1. The Secure Provider Portal 
  2. Phone​
    1-833-552-3876
  3. Fax​
    Medical PA Fax: 1-833-238-7694
    BH Inpatient Fax: 1-833-596-2768
    BH Outpatient Fax: 1-833-596-2769
    Pharmacy PA Fax: 1-866-399-0929

For Prior Authorization Form, please visit our Manuals, Forms, and Guides page.

For Behavioral Health UM Prior Authorization Guidelines, please visit our Manuals, Forms, and Guides page.

  • For Behavioral Health, please see state bulletin regarding COVID-19 flexibilities for specifics related to BH prior authorizations.

Visit the Prior Authorization section of this website as well as the Provider Manual for more information.

Carolina Complete Health will use National Imaging Associates, Inc. (NIA) to provide the management and prior authorization of non-emergent, advanced, outpatient imaging services.

Please use the Help STAT! link on the upper right hand corner of this website to quickly be connected with the Carolina Complete Health Network team. This information is routed to an internal email address, managed during business hours. 

You may also contact Network Relations by calling 1-833-552-3876 or emailing Networkrelations@cch-network.com

Advanced Medical Homes (AMHs), Hospitals, and Health Systems, are encouraged to reach out directly to their designated Provider Engagement Coordinator.