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Medical Policy Innovation

How we do things differently

Medical policy has an enormous impact on patients and the physicians and clinicians who serve them because medical policy determines what care the insurance plan will pay for. In fact, 90% of physicians and clinicians surveyed in 2021 told us that it is important to them that those who provide care to patients greatly influence the medical policy of the health plan.   

Physicians guide our medical policy in a way that is unmatched by any other prepaid health plan in North Carolina. We strive to have policies that are provider-friendly and give the best care to patients.

We do this in two ways. First, Carolina Complete Health Network organizes groups of medical experts to vet the plan’s medical policy. Second, physicians sit on the plan’s board of directors, and they endorse any recommended changes to the policy. 

Medical Policy Advisory Workgroups

  • Primary Care
  • Emergency Medicine
  • Behavioral Health
  • Pediatric
  • Obstetrics

Any physician (MD, DO, NP, PA) or behavioral health clinician can participate in their specialty-matched Medical Policy workgroup as long as they are a participating CCH provider. For more information on getting involved with Medical Policy, please email for eligibility criteria. 

Provider Advisory Workgroups

The CCHN Provider Advisory Committee (PAC) is a committee utilized to communicate Carolina Complete Health’s (CCH’s) programs and processes to its provider network allowing for collaboration and feedback through discussion with the providers. CCHN Provider Advisory Committee provides input on the CCH Provider Support Plan, Provider Training Plan, Provider Engagement Strategy, Medical Policy Strategy, Innovations Programs, Administrative simplification, and more. 

The Practice Manager Advisory Council (PMAC) will report to the PAC. The PMAC will help bridge the gap between clinical policy, payment policy, and operations, providing a more holistic approach by bringing everyone to the table to help drive innovation and change.  Practice managers, or their designee, are welcome to join. One priority identified by the PMAC is panel management and the process by which PCPs can request to reassign members due to dismissal from the practice. There is now an administrative simplification workgroup to develop a streamlined guide for this with all five PHPs.

The HCBS Council is dedicated to providers of Durable Medical Equipment, Personal Care Services, Home Health, and Long-Term Services and Supports providers.  This group will meet with CCHN to discuss barriers and concerns as well as to brainstorm solutions..

If interested in participating, contact email for eligibility criteria. 

Medical Policy Team