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

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.
  • Carolina Complete Health (CCH) has developed a new policy for CAR-T Cell Therapy.  Previously, CCH has attested to state policy 11A-17. The new CCH specific policy is less restrictive, removing the absolute requirement for a bone marrow biopsy prior to the provision of CAR-T Cell Therapy. Review new policy NC.CP.MP.500.
  • The Physician’s Office Lab Testing policy has been updated to include additional in-office labs along with resources for additional guidance specific to codes 87480, 87510, and 87798.  

The NC Incident Response Improvement System (IRIS) sites transitioned from the dhhs.state.us link to the ncdhhs.gov site. IRIS is a web based incident reporting system for reporting and documenting responses to Level II and III incidents involving consumers receiving mental health, developmental disabilities and/or substance abuse services. The IRIS Training site moved on November 4, 2022 from https://iristraining.dhhs.nc.us to  https://iristraining.ncdhhs.gov.   The Live IRIS site will continue to redirect users from https://iris.dhhs.state.nc.us/ to https://iris.ncdhhs.gov until December 31, 2022.  We ask that all IRIS users bookmark the updated live site before December 31, 2022, to ensure easy access. 

The NC Incident Response Improvement System (IRIS) is now operational for all users.  IRIS is a web-based incident reporting system for reporting and documenting responses to Level II and III incidents involving consumers receiving mental health, developmental disabilities and/or substance abuse services. Please enter all paper incident reports (faxed or not faxed) into the system.  If you receive an error message, please send a screenshot of the error message to QOC_CIR@carolinacompletehealth.com for assistance.