You will not need to sign a new agreement. Your existing WellCare agreement remains in effect after the merger and will cover members under the new state-wide unified health plan, named Carolina Complete Health.

You will not need to sign a new agreement. Your existing Carolina Complete Health agreement remains in effect after the merger and will cover members under the new state-wide unified health plan, named Carolina Complete Health.

One of your contracts was terminated so there would be only one agreement between you and the merged plan. Providers do not have to take action and will be considered in-network under the merged plan on
4/1/26.

Importantly, whichever contract is maintained for Medicaid will remain in effect after the merger and will cover members under the new state-wide unified health plan.

Contracts for Wellcare Medicare, Ambetter of North Carolina Inc., and Tailored Plan Physical Health with Trillium and Partners remain unaffected by the merger.

If you currently hold a Medicaid contract with Carolina Complete Health or WellCare of North Carolina, you will be considered in-network on 4/1/26, and therefore your members will stay assigned to you.

Additionally, with current WellCare Medicaid members being automatically transitioned to the unified health plan, these members will not need to change their PHP.

There is no re-credentialing or additional application process required as part of this merger on 4/1/26.

Wellcare Medicare will continue operating as it does today and will retain the Wellcare Medicare name. If you currently hold a Wellcare Medicare contract, it will remain active. Providers interested in joining the Wellcare Medicare network can submit a request through the online form.

Carolina Complete Health offers a free solution for payment by Electronic Funds Transfer (EFT) and Electronic Remittance Advice (835)/Explanation of Payment (ERA/EOP) through PaySpan®. If you are not already registered, create a new account by registering at payspanhealth.com or calling 1-877-331-7154, option 1.

For claims with a date of service prior to 4/1/2026, WellCare of NC and Carolina Complete Health will continue to process claims and encounters separately under timely filing guidelines.

For claims with a date of service on or after 4/1/2026, providers will submit their claims to the unified health plan. Claims will be processed in the Carolina Complete Health system.

For dates of service 4/1/26 and after, submit Standard Plan claims for the unified health plan using one of the following methods:

• Availity Essentials
• Carolina Complete Health Secure Provider Portal
• Clearinghouse/EDI: Payer ID 68069
• Mail: PO Box 8040 Farmington, MO 63640-8040

Legacy systems for WellCare of NC will remain operational for historical claim access. Historical claim access will be supported for 2 years post 4/1/2026. Two (2) years of historical claims will be accessible via the legacy provider portal.
 

For dates of service 4/1/26 and after, claims will be processed using the Carolina Complete Health claim systems and providers should use the Carolina Complete Health Payer ID (68069) if submitting through EDI/Clearinghouse.

Claims with dates of service 4/1/26 or after will be processed by Carolina Complete Health and the remittance will be designated as Carolina Complete Health. Providers can receive electronic funds transfer and electronic remittance through PaySpan. To register for Payspan, view the PaySpan Provider Guide.

The unified health plan will operate under the WellCare NC Tax ID Number and will be named Carolina Complete Health. If you are contracted with both entities and received a termination letter regarding one of your contracts, no action is required on your part. Your remaining contract will stay active, and you will continue to be considered in‑network as of April 1, 2026.

For dates of service 4/1/26 and after, standard plan Medicaid claims should be submitted to the unified health plan using one of the methods outlined below:

• Availity Essentials (selecting CCH as the payer)
• CCH Secure Provider Portal
• Clearinghouse/EDI: CCH Payer ID 68069
• Mail: PO Box 8040 Farmington, MO 63640-8040

The Carolina Complete Health (CCH) portal options include the CCH Secure Provider Portal and Availity Essentials. Providers who do not currently use the CCH portal may register after 3/1/26.

We are closely monitoring our market share, and while we are close to the cap in a couple of regions, we do not believe the cap will have a material impact on our membership. We are also actively working with the State to ensure compliance. The State will make auto-assignment adjustments to address a situation where we are over the cap. This will take place beginning 4/1/2026.

The necessary adjustments to stay under the cap would be handled through the State’s auto-assignment process, and we do not anticipate manual reassignments. For regions where the combined member enrollment reaches the 40% ceiling, the Department will turn-off auto-assignment to Carolina Complete Health until the member enrollment falls below 40%. This will take place beginning 4/1/2026.

The unified health plan will use a single secure provider portal, the Carolina Complete Health secure portal, for dates of service 4/1/26 and after. Providers who have never used this portal (those who currently hold WellCare Medicaid contracts only and will be new to the Carolina Complete Health network) may register for this portal beginning 3/1/26. Our provider education and engagement teams will host portal trainings beginning 2/26/26. Providers may also use Availity Essentials to submit claims and authorizations electronically.

For CCH providers, the public Carolina Complete Health Network website will remain.  WellCare providers should begin using this webpage upon go-live for updated materials (i.e. provider and billing manuals, contacts, and provider tools).

Legacy systems for WellCare of NC will remain operational for historical claim access. Historical claim access will be supported for 2 years post 4/1/2026. Two (2) years of historical claims will be accessible via the legacy provider portal.

For dates of service 4/1/26 and after, providers should use the single unified health plan portal (Carolina Complete Health Secure Portal) or Availity Essentials (selecting CCH as the payer) to check eligibility, submit claims, authorizations, and more.

The future structure for Provider Experience team assignments has not been finalized yet. For the time being, nothing changes, you should continue working with your current representative just as you do today. As soon as assignments for the period beginning 4/1/2026 are finalized, we will communicate that information. In the meantime, if you need anything at all, you’re always welcome to reach out to your current assigned representative.

When calling the WellCare Provider Services Call Center, providers will be informed of the merger and directed to the call center of the unified health plan, under the Carolina Complete Health name. In the message they will be provided with the 1-833-552-3876 number for future calls and informed that post 6/30/26 the WellCare line will no longer be in service.

Yes. There will be bi-weekly information sessions beginning 2/19/26. Secure provider portal trainings will launch on 2/26 and will occur bi-weekly. We will also share regular updates through provider bulletins and newsletters. Providers should also bookmark the integration landing page where new resources and training will be posted. You may also reach out to your Provider Engagement representative at anytime with questions.

The future structure for Provider Experience team assignments has not been finalized yet. For the time being, nothing changes, you should continue working with your current representative just as you do today. As soon as assignments for the period beginning 4/1/2026 are finalized, we will communicate that information. In the meantime, if you need anything at all, you’re always welcome to reach out to your current assigned representative just as you do today.

The future structure for Provider Experience team assignments has not been finalized yet. For the time being, nothing changes, you should continue working with your current representative just as you do today. As soon as assignments for the period beginning 4/1/2026 are finalized, we will communicate that information. In the meantime, if you need anything at all, you’re always welcome to reach out to your current assigned representative just as you do today.

WellCare Medicaid members received an announcement letter in January, followed by a series of informational materials delivered through multiple channels and platforms. These may include, but are not limited to, direct mail, text message onboarding journeys, paid media (digital and traditional), social media (paid and organic), public relations, and grassroots activities across all six regions.

These communications will ensure that members understand what is changing, what is staying the same, and how to access their benefits. No action will be required from members, and there will be no impact on their current Medicaid coverage.

Medicaid members will keep the same Medicaid ID number and it will be printed on the Member ID card. WellCare Medicaid members will be sent a new Carolina Complete Health ID card and welcome packet before 4/1/26

Members are assigned at the Advanced Medical Home (AMH) group level and this will be listed on the member ID card.

Active open authorizations will transfer over to the unified health plan. Historical authorizations (past 18 months prior to 4/1/26) will also migrate over. If a service was approved before 4/1/26 but is performed on or after 4/1/26, the claim will pay correctly when filed with Carolina Complete Health. For example, an authorization is requested and approved for a 60-day period from 3/15/26 - 6/15/26. The authorization will be valid for services provided after 4/1/26, even though it was approved while the member was covered under WellCare of NC prior to the integration date. Providers can view authorizations in the secure provider portal.

Yes, behavioral health outpatient therapy will require prior authorization following 24 visits, which resets every State FY (July 1). The following codes will apply to for outpatient therapy: 90832, 90834, 90837, 90846, 90847, 90849, and 90853. Authorization will continue to be required for Research-Based Behavioral Health Treatment for Autism Spectrum Disorder (i.e., ABA). Providers should also refer to the Carolina Complete Health Pre-Auth Tool.

Effective 4/1/26, PT/OT/ST authorizations can be submitted directly to the unified health plan. Providers should submit authorization requests to the health plan through the Carolina Complete Health Secure Portal, Availity Essentials, phone or fax. Please use the Pre-Auth Tool to check on a specific service or procedure.

Required documentation includes:

• Signed MD Order within the last 6 months
• Evaluation/progress notes from the past 3 months Plan of Care
• For continuations: new order (if previous is signed & dated longer than 6 months ago) and an updated plan of care stating frequency and duration of therapy.

PT/OT/ST FAQ (PDF)

The topic of Utilization Management will be covered in our Provider Information Sessions launching 2/19/26. Additionally, there will be necessary updates made to our Provider Manual plus additional resources, such as a UM Quick Reference Guide, developed for provider guidance. Beginning April 1, 2026, providers may call Provider Services at 1-833-552-3876 to reach medical management and care management departments. Provider may also work directly with their designated Provider Engagement and Relations representative.

Quality performance data remain accessible via Carolina Complete Health secure provider portal and report packets sent prior to Quality meeting. Carolina Complete Health’s current incentive model will continue for the merged entity. Measures, targets for each year will be distributed through assigned Provider Engagement teams. Providers will continue to use Carolina Complete Health’s Provider Portal.

CoC agendas for Medicaid will look like the current Carolina Complete Health agendas.