Provider Updates

Frequently Asked Go-Live Questions

Yes! The Medicaid ID and CCH Member ID are the same number.

Yes! During the transition period, you can see a primary care patient and be paid even if you are not the PCP on their member card. You do not have to turn patients away and you will be paid for the service. The AMH PMPM capitated payments will go to the assigned PCP.

The member, or you and the member together, can contact Member Services at 1-833-552-3876  to update or change the PCP.

Common Causes of Claims Processing Delays and Denials

  • Missing rendering Taxonomy*
  • Missing billing Taxonomy*
  • Missing attending Taxonomy (Institutional)*
    • *Taxonomy numbers must also align with what is in NCTracks.
  • Incorrect Form Type
  • Diagnosis Code Missing Digits
  • Missing or Invalid Procedure or Modifier Codes
  • Missing or Invalid DRG Code
  • Explanation of Benefits from the Primary Carrier is Missing or Incomplete
  • Invalid Enrollee ID
  • Invalid Place of Service Code
  • Provider TIN and NPI Do Not Match
  • Invalid Revenue Code
  • Dates of Service Span Do Not Match Listed Days/Units
  • Missing Physician Signature
  • Invalid TIN
  • Missing or Incomplete Third Party Liability Information

Common Causes of Up Front Rejections

  • Unreadable Information
  • Missing Enrollee Date of Birth
  • Missing Enrollee Name or Identification Number
  • Missing Provider Name, Tax ID, or NPI Number
  • Missing Medicaid Number
  • The Date of Service on the Claim is Not Prior to Receipt Date of the Claim
  • Dates Are Missing from Required Fields
  • Invalid or Missing Type of Bill
  • Missing, Invalid or Incomplete Diagnosis Code
  • Missing Service Line Detail
  • Enrollee Not Effective on The Date of Service
  • Admission Type is Missing
  • Missing Patient Status
  • Missing or Invalid Occurrence Code or Date
  • Missing or Invalid Revenue Code
  • Missing or Invalid CPT/Procedure Code
  • Incorrect Form Type
  • Claims submitted with handwritten data or black and white forms

For more information about required and conditional fields for claims, please reference page 43 of the Carolina Complete Health Billing Manual under Manuals, Forms, and Guides.

Carolina Complete Health does not require referrals from the PCP for members to seek care with in-network specialists. However, some specialist offices may have their own unique policies and procedures related to referrals. Carolina Complete Health educates members to seek care or consultation with their Primary Care Provider (PCP) first​. When medically necessary care is needed beyond the scope of what a PCP provides, PCPs are encouraged to initiate and coordinate the care members receive from specialist providers to support the Medical Home model. Carolina Complete Health encourages specialists to communicate and coordinate care back to the member’s PCP. Out-of-network specialist will require a Prior Authorization with Carolina Complete Health. Visit our Prior Authorization Page for more information on how to submit requests.

Carolina Complete Health can arrange and pay for member transportation to and from appointments for Medicaid-covered services. 

How to Get Non-Emergency Transportation: 

Call ModivCare, Carolina Complete Health's transportation provider, up to 30 days before the appointment to arrange for round-trip transportation. There is no limit to the number of trips during the year between medical appointments, healthcare facilities, or pharmacies.

ModivCare Support Numbers:

  • 855-397-3601: Member Reservations
  • 855-397-3604: Provider Transportation Line (Non-Emergency Ambulatory Transportation and other transportation subcontractors)
  • 855-397-3606: Facility Transportation Line (for Dialysis Centers and other facilities with high utilizing members)

How far in advance can Members make reservations?

  • Transportation must be scheduled at least 2 business days before but not more than thirty 30 days before the date of the appointment.
  • Members may schedule recurring “subscription” trips (e.g. for dialysis) 3 months in advance

Urgent Appointments:

  • Urgent trips for covered services may be scheduled with less than 2 days’ notice. Examples include:
    • Sick visits
    • Hospital discharge requests
    • Life-sustaining treatment

A customer service representative will ask for the following information:

  • Member's full name, current address, and phone number
  • Member's Medicaid ID number
  • The date of the appointment
  • The name, address, and phone number of where the member needs to go
  • The name, address, and phone number of the Physician/Provider the member is seeing
  • The medical reason the member needs the ride
  • The type of appointment (for example: doctor/provider visit, lab test, therapy appointment)
  • The type of assistance or mobility aid required for the member

For Non-Emergency Medical Transportation (NEMT) fact sheets, please see the NEMT page on the County Playbook, available from North Carolina Medicaid Division of Health Benefits.

Carolina Complete Health Providers are able to create an account for the Secure Provider Portal by following the link in the upper right hand corner of this site labeled 'Provider Portal Login'. Next, click the orange button labeled 'Create an Account' and the follow the prompts. Once submitted, you will receive an email letting you know when you are verified and can return back to the portal to log in. We recommend identifying at least two individuals to act as the Secure Portal Account Manager. If you need to be assigned as the Account Manager, please email For more information on Account Manager privledges, please see the Provider Portal Account Manager Guide on Manuals, Guides, and Forms page. 

Yes! For assistance with interpreter services please use the Language Line:

  • Toll Free 1-866-998-0338
  • Account Number 13982 
  • Medicaid PIN #6329

You can subscribe using this form! Please also check out our Provider Communications page for a summary of Newsletters and Special Bulletins to date.

Pharmacy Prior authorizations can be submitted in 3 ways: 

  1. Cover My Meds Portal
  2. Fax​
  3. PA Prescriber Help Desk (EPS)

Sharing from the July 22, 2021 Medicaid Bulletin

Durable Medical Equipment (DME) is covered under NC Medicaid Managed Care for beneficiaries enrolled in a managed care plan and under NC Medicaid Direct for those beneficiaries who remain in NC Medicaid Direct. DME is NOT carved out of managed care.

Pharmacies and other providers that provide DME to NC Medicaid Managed Care beneficiaries should contract with or update contracts with health plans to include a DME agreement to be able to bill DME products, which are a DME benefit, for NC Medicaid Managed Care beneficiaries. For beneficiaries enrolled in NC Medicaid Direct, providers can continue to submit claims through NCTracks. For beneficiaries enrolled in managed care plans, please contact the plan directly for more information.

To contract with Carolina Complete Health, please email

Contact your assigned Provider Engagement Administrator first. They will connect you with your designated Network Support Specialist to resolve claims issues and questions.

To obtain a copy of the fee schedule, reach out to Provider Relations at

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

How to Secure Prior Authorization (PDF)

Prior authorizations can be submitted in 3 ways: 

  1. The Secure Provider Portal 
  2. Phone​
  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.

For Pharmacy Prior Authorization forms, please visit our Pharmacy page.

Which Drugs are covered?

The Preferred Drug List (PDL) is a list of drugs covered by Carolina Complete Health. Carolina Complete Health works with the State of North Carolina to ensure that medications used to treat a variety of conditions and diseases are covered. The Preferred Drug List includes drugs you receive at retail pharmacies. Carolina Complete Health adheres to the NC Medicaid Preferred Drug List.

  • The Preferred Drug List (PDL) allows NC Medicaid to obtain better prices for covered outpatient drugs through supplemental rebates. The PDL was authorized by the NC General Assembly Session Law 2009-451, Sections 10.66(a)-(d).
    • Prescribers are encouraged to write prescriptions for “preferred” products.
    • Prescribers may continue to write prescriptions for drugs not on the PDL.
    • If a prescriber deems that the patient’s clinical status necessitates therapy with a non-preferred drug, the prescriber will be responsible for initiating a prior authorization request.
    • Prior authorization requirements may be added to additional drugs in the future.
    • Submit Proposed Clinical Policy Changes to the PDL
    • Preferred Drug List Review Panel

To view the Preferred Drug List, visit the Manuals and Forms page.