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.
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.
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.
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 email@example.com. 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:
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 NetworkRelations@cch-network.com
Independent Advanced Medical Homes and Local Health Departments should reach out to their Provider Engagement Coordinator
Health-system affilited Advanced Medical Homes and other hospital-based health system practices should reach out to their Corporate Connections Provider Engagement Coordinator
All other providers are welcome to reach out to Provider Relations and Support through email: NetworkRelations@cch-network.com or by using Help STAT! You can also reach Provider Relations by phone: 1-833-552-3876.
To obtain a copy of the fee schedule, reach out to Provider Relations at NetworkRelations@cch-network.com
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.
For Pharmacy Prior Authorization forms, please visit our Pharmacy page.
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.
To view the Preferred Drug List, visit the Manuals and Forms page.