Coming Soon: After September 23, 2021

Most users will start using our new EntryKeyID. This new way to log in gives you a single ID and password.  Log in once.  Access all your registered health plans with one account.

Action Required:

You will be asked to reset your password the first time you log in.

If you do not have an EntryKeyID, you will be asked to create one to register or re-register your health plans.  Learn More.

 Reminder:  Taxonomy Accuracy and Inclusion on EDI claims

Please verify that the Rendering Taxonomy, Billing Taxonomy, and Attending Taxonomy (for institutional claims) are completed fields and align with what is in NCTracks. For further assistance, please reach out to your Provider Engagement Coordinator or the Provider Relations and Support Team. 

 

There is a new resource on the Manuals, Forms, and Guides page with additional tips for submitting claims:


Announcements

The North Carolina Department of Health and Human Services Division of Health Benefits and North Carolina AHEC in conjunction with the five Medicaid managed care health plans will host a Virtual Statewide Quality Forum on October 12 from NOON-1:30 PM to help providers, practice managers, and quality managers succeed with Medicaid Managed Care quality initiatives.

Topics will include DHHS NC Medicaid Managed Care Quality Strategy, statewide performance improvement initiatives for SF2022 (childhood immunizations, diabetes control, timeliness of prenatal care), Health Plan and AHEC Provider Supports, and Quality Measure Data and Reporting.  The session also includes a question and answer forum for participants.

Register for the quality forum in advance.

COVID-19 Vaccine Information

COVID-19 vaccines are available to everyone 12 and older. For more information visit https://covid19.ncdhhs.gov/vaccines.

Don't Wait to Vaccinate

Nearly all new COVID-19 cases are people who are not fully vaccinated. Get a tested, safe and effective vaccine to protect yourself and others against hospitalization and death. Find a vaccine location near you.

About COVID-19

NCDHHS: COVID-19 Vaccine Communications Toolkit

 

What: Claims support office hours for providers

When: Tues and Thurs / every 2nd and 3rd week of each month / 4 – 5 pm

Duration: For 8 months starting August 19, 2021

Provider must submit email for link to Zoom meeting to NCCH_Claims_NetworkOperations@carolinacompletehealth.com

Providers can submit questions in advance to NCCH_Claims_NetworkOperations@carolinacompletehealth.com

Carolina Complete Health Advanced Medical Homes and Local Health Departments can visit 'Reports' from the secure provider portal to view their capitated payment summary, as well as a detailed list of members attributed to the payments. Please reach out to your Provider Engagement Coordinator for assistance!

Carolina Complete Health will issue the first set of medical home fee payments to providers on or before Saturday, July 24, 2021. Paper checks will be sent by Priority Mail this month. Beginning in August, payments will be distributed on the 20th of each month.

We recently identified an issue where all Carolina Complete Health (CCH) member ID cards were printed with NC Health Choice on the front of the card, which is only accurate for a subset of Medicaid Managed Care members.  This error has been corrected and new member ID cards are being mailed over the next week reflecting this correction.  Going forward, all CCH member ID cards will distinguish between Medicaid and NC Health Choice as the member’s benefit.

We understand the importance of this benefit distinction for primary care clinicians providing vaccines to our members.   If you encounter difficulties with payment for vaccines related to this matter, please contact CCH at 1-833-552-3876 for Provider Services assistance.

Additionally, given that NC Health Choice members are not subject to EPSDT provisions, remember to verify Medicaid status to minimize any adverse impact.  CCH will work with our providers to ensure that beneficiaries receive the appropriate benefits.

Finally, there are several ways to confirm member benefits, with the preferred method being a check of eligibility on NC Tracks.  You can also refer to the CCH Provider Portal or call CCH Provider Services at 1-833-552-3876.  If you would like assistance with your panel assignments, please call your CCH Network Provider Engagement Coordinator or email networkrelations@cch-network.com.


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

Carolina Complete Health's check write schedule is Tuesday and Friday beginning 7/13/21

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.

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

  • PaySpan: A Faster, Easier Way to Get Paid (PDF)
  • If you are brand new to Payspan, there are additional validation steps required to complete the registration. Carolina Complete Health is advocating for clarification on these steps and will educate our providers with more information as soon as it is available
  • To contact Payspan: Call 1-877-331-7154, Option 1 – Monday thru Friday 8:00 am to 8:00 pm est.

 

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.