Contract Request Form

High volume of contracts:

Since July 1st, we have experienced a significant influx of Tailored Plan contracts, far exceeding our usual volume. Due to unexpectedly high volume, the turnaround time for processing may exceed 5 business days.

What we are doing:

In response, we have mobilized multiple teams to assist in processing these contracts efficiently. Our teams are working diligently to process contracts as quickly as possible while maintaining accuracy and attention to detail. We appreciate your flexibility and patience during this time as we manage this temporary surge, with the goal of returning to our normal processing time as soon as possible.

What you can do:

Our team will reach out to providers if there is any additional information needed to process the contract request. If you have already submitted a contract request form, you do not need to submit another. There are flexibilities in place through 1/31/25 including relaxing prior authorization requirements and reimbursing at 100% of the NC Medicaid fee-for-service rate for out-of-network providers. See more details on Tailored Plan Launch Flexibilities.

Thank you for your patience and understanding!

Thank you for your interest in becoming a Carolina Complete Health Network provider.

In addition to our Standard Plan contracting, Carolina Complete Health is also currently contracting providers for physical health services with two Tailored Plans – Partners Health Management and Trillium Health Resources. View our Tailored Plan Information Guide (PDF)

The form below should only be used to request contracts. If you need to inquire whether a practitioner is linked to your group, notify us of any provider data discrepencies, or have other questions, reach out to your assigned Provider Network Support Specialist or email the team at: networkrelations@cch-network.com.

NOTE: Prior to contracting with Carolina Complete Health, providers must be credentialed with NC Medicaid. NCTracks is the “system of record” for provider enrollment data. View our Provider Guide: Provider Enrollment and Data (PDF) for more information.

We look forward to working with you to improve the health of the community.

Required fields are marked with an asterisk (*)

Please indicate the network(s) you would like to join: * Carolina Complete Health Standard Plan Trillium Tailored Plan (Physical Health Providers) Partners Tailored Plan (Physical Health Providers)

First Name *

Last Name *

Phone Number *

Email Address *

Entity Tax ID *

Entity Billing NPI *

Entity Medicaid Number

Legal Entity Name *

Provider Mailing Address *

City *

State *

Zip *

County *

Facility Type *

Facility/Agency Type *

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