North Carolina continues to transition Medicaid from a fee-for-service delivery system to Managed Care. Tailored Plans are scheduled to launch in April 2023 (delayed from an original launch in December 2022). Tailored Plans will support members with significant behavioral health needs.
Carolina Complete Health contracting providers for physical health for two Tailored Plans – Partners Health Management and Trillium Health Resources.
Tailored Plans will cover the same physical health services as Standard Plans.
Additionally, Tailored Plans will cover specialized services for individuals with significant behavioral health conditions, intellectual/developmental disabilities (I/DDs), and traumatic brain injury (TBI), including Innovations and TBI waiver enrollees.
Carolina Complete Health was selected by two Tailored Plans – Partners Health Management (Partners) and Trillium Health Resources (Trillium). Together, we will serve over 55,000 Tailored Plan members.
As the first and only Provider-Led Entity, we look forward to working with you to improve access to health care in North Carolina.
While the launch of Tailored Plans has been delayed until April 2023, Carolina Complete Health remains focused on contracting providers for physical health.
When Tailored Plans launch, NC Medicaid will no longer reimburse providers directly for physical health services rendered to Tailored Plan members.
In accordance with NC DHHS guidance, providers should have fully executed contracts in place to be included in the first day of the beneficiary choice period.
If you do not have a contract for the Tailored Plan network, you will be considered ‘out-of-network’ and could be subject to reduced reimbursement rates for physical health services.
Our team of network professionals is available to assist you in meeting critical dates for contracting.
Please call 1-855-688-6589 or email firstname.lastname@example.org