Claims, Billing, and Payment
Billing Manual and Provider Guides
- Billing Manual (PDF)
- FQHC Billing Guidance
- CCH Standard Plan Out of Network (OON) Provider Guide (PDF)
- Claims and Billing FAQ
- Claims Guide- Duplicate Submissions (PDF)
- Claims Submission Reminder Guide (PDF)
- Coordination of Benefits Walkthrough (PDF)
- EPSDT Claims and Authorizations (PDF)
- Guidance for Submitting CLIA Claims (PDF)
- Tailored Plan Billing with Partners and Trillium for Physical Health Providers (PDF)
- Provider Taxonomy Guide (PDF)
- Provider FAQ- Pended Claims Requiring Additional Information (PDF)
- Pediatric Provider Billing Guidance (PDF)
- Provider Guide for 340B Drug Claims (PDF)
- 835 EDI Companion Guide (PDF)
- 837 EDI Companion Guide (PDF)
Electronic Funds Transfer (EFT)
Payspan Migration to Zelis Provider Notice
With the Zelis acquisition of PaySpan, Carolina Complete Health in coordination with its parent company, Centene Corporation, will transition to Zelis for both claims and non-claims payments.
The transition will occur in phases, with Medicare, Medicaid, and Ambetter programs moving in early 2027. To ensure uninterrupted access to electronic payments and remittance information across all participating lines of business, we encourage you to enroll now. Once enrolled, any additional eligible lines of business that move to the new platform will automatically be included, and no further action will be required.
How the Move to Zelis Impacts You
The transition to Zelis will offer greater efficiency and more choice in how you receive claims payments and remittance data. Your options include:
- ZAPP Edge – the Zelis premium payments experience for providers, offering direct settlement into the provider bank accounts via ACH plus data and financial performance insights from 485+ payers in a single portal.
- Virtual Card (VCC) – a one-time-use virtual card.
- ePayment Center – no-cost standard EFT/ERA solution that delivers payment via ACH.
- Paper Check – no-cost paper check delivery via USPS (default payment method).
What You Need to Know
- If you are already enrolled in Zelis payments on ZAPP Edge to receive claim payments via ACH or VCC, no action is needed. Following our move to Zelis, payments from [Payer] will be sent according to your current Zelis enrollment, fee schedule, and other terms and conditions.
- If you are not enrolled in Zelis payments on ZAPP Edge, you can avoid any disruption to your payment preferences by enrolling now and selecting your preferred electronic payment method using the contact information below.
- ZAPP Edge or VCC: call a Zelis Advisor at 855-496-1571.
- Centene Claims ePayment Center (no-cost standard EFT/ERA): visit centeneclaimspayment.epayment.center/Registration.
- If you are not already enrolled with Zelis for VCC or ZAPP Edge and do not enroll in the free ePayment Center, payments will be sent by paper check through USPS.
- If you receive non-claims payments, you may have additional registration steps to complete. Registration for non-claims payments can be completed by visiting CenteneAlternativePayments.epayment.center. More information on this process will be provided closer to the transition.
Questions
Carolina Complete Health and Zelis are committed to supporting you throughout this transition. If you have questions about your payment options, need additional help making your selection, or want to change your payment method, please use the contact information below.
- ePayment Center: call 855-774-4392 or email help@epayment.center.
- ZAPP Edge or VCC: contact Zelis Client Services at 877-828-8770.
| Payment Option | How It Works | Cost to Provider | Provider Action |
|---|---|---|---|
| EFT/ERA, standard | Deposits payments directly into the provider’s bank account through standard EFT/ACH. Providers may also enroll for electronic remittance advice. | No fee | Register through the Centene Claims Payment ePayment Center or call 1-855-774-4392. |
| Paper check | A physical check is mailed through USPS. This is the default if the provider does not have another applicable payment preference on file. | No fee | No enrollment is required. Providers should ensure their mailing address is current. |
| ZAPP Edge, formerly ACH+ | Provides direct deposit and access to consolidated payments, remittance data, reporting and other features across participating Zelis payers. | *Fee applies under the provider’s agreement with Zelis | To review the service, applicable fee and enrollment terms contact Zelis at 1-877-828-8770. |
| Virtual Credit Card (VCC) | A one-time-use card is processed through the provider’s existing merchant terminal. | *Standard merchant or credit card processing fees apply | To select or change this payment preference contact Zelis. |
- Payspan is an innovative web-based solution for Electronic Funds Transfers (EFTs) and Electronic Remittance Advices (ERAs). By using Payspan, you can speed up the processing and payment of your claims.
- Note: In November of 2022, Zelis, a company modernizing the business of healthcare, completed the acquisition of Payspan. Providers should continue using the Payspan payment portal: login or register.
- Payspan: A Faster, Easier Way to Get Paid
- To contact Payspan: Call 1-877-331-7154, Option 1 – Monday thru Friday 8:00 am to 8:00 pm est.
Provider Claims Schedule
| Claim Type | Claims Schedule |
|---|---|
| Medical | Monday, Wednesday and Friday (Effective 7/28/25). Payment issued to providers the following business day. |
Envolve Vision | Weekly, Wednesday |
NIA | Weekly, Tuesday and Friday |
Pharmacy | Weekly, Wednesday |
Definitions
- Paid in Full - The claim has been adjudicated, processed and reimbursed in accordance and with the executed provider contract on file including the coordination of benefits, as applicable per claim.
Refunds and Overpayments
Claims are routinely audited for payment error(s). Claims identified as underpaid or overpaid will be reprocessed appropriately. Providers are responsible for reporting overpayments or improper payments to the health plan. Providers have the option of requesting future offsets to payments or may mail refunds and overpayments, along with supporting documentation (copy of the remittance advice along with affected claims identified), to the following addresses according to line of business:
| Line of Business | Address |
|---|---|
| Carolina Complete Health Standard Plan | Carolina Complete Health PO Box 200122 Dallas, TX 75320-0122 |
| Ambetter of North Carolina Inc. | Ambetter of North Carolina PO BOX 207802 Dallas, TX 75320-7802 |
Partners Tailored Plan (Physical Health) *Remains in effect through the claims runout period | Partners Health Management PO Box 604293 Charlotte, NC 28260-4293 |
Trillium Tailored Plan (Physical Health) *Applicable for checks and recovery payments received before October 1, 2026. Do not use for payments dated on or after 10/1/2026. | Carolina Complete Health Inc. PO Box 200673 Dallas, TX 75320-0673 |