Network Provider FAQs

A:  The General Assembly passed legislation in 2015 that will transform our state-operated, fee-for-service Medicaid program into a new program that will rely on three (3) prepaid health plans to administer Medicaid benefits statewide and (1) provider-led plan to administer Medicaid benefits in Regions 3 and 5, Carolina Complete Health (CCH). 

A:  Both will have operations based in North Carolina with local service centers, leadership teams, and representatives to assist North Carolina providers and Medicaid patients.

A:  The PPA with your practice/facility includes a provision that allows you to cancel the agreement at any time with one hundred twenty (120) days’ notice.  

A:  Yes, the PPA includes financial incentives that could allow primary care physicians to earn more than the Medicaid fee schedule. In addition, the reimbursement provisions in the agreement allow for adjustments to be made to reimbursement and financial incentive programs if applicable, once the state completes the actuarial rate setting process.

A:  Insurance company solvency rules require health plans to maintain large sums of capital reserves to cover claims, liabilities and to protect patients. For NCMS and NCCHCA, these rules meant a capital partner was necessary.  In addition, both organizations wanted a partner that brought expertise in Medicaid and health plan operations to the table.

A:  With the goal of having the opportunity to shape healthcare delivery for North Carolina Medicaid patients and physicians/providers/facilities under the new program, the North Carolina Medical Society completed a rigorous selection process, interviewing a number of potential capital and risk-bearing partners.  Based on the selection criteria, Centene was chosen.