Beginning February 1, 2022, the following changes will be made to Outpatient Pharmacy Clinical Coverage Criteria and the accompanying prior authorization request forms:
Carolina Complete Health Quick Reference Guide Form (PDF)
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:
Registration is free and easy! Use the Log In button in the upper right hand corner of this webpage
Using the Secure Provider Portal (PDF), providers will be able to:
Claims may be submitted in 3 ways:
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?
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:
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.
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.