Manuals, Forms, and Guides

Provider Manuals

• Provider Manual (PDF)
• Provider Billing Manual (PDF)

Provider Forms

Claims Complaints/Appeals

• Provider Claim Complaint/Appeal Form (PDF)

Prior Authorizations

• Prior Authorization Form (PDF)
  • For tip sheets and additional guidance, visit our Prior Authorization Page

Personal Care Services Requests

• Personal Care Services 3051 Request Form (PDF) 
  • For more information, visit our PCS Page

PCP Change Form

• Primary Care Provider (PCP) Change Fax Form (PDF)
  • The change form should only be used to move patients into your practice, if you need to disenroll a patient refer to the policy on Member Reassignment and reach out to your Provider Engagement Coordinator for assistance.

Member Reassignment Form

• PCP Initiated Member Reassignment (PDF)
  • To assist you with multiple member reassignment requests, please use the Member Reassignment Worksheet (PDF) and reach out to your Provider Engagement Coordinator for support! Thank you! 

Massage Therapy ILOS 

• Massage Therapy Acknowledgement Form (PDF)
• Massage Therapy Assessment Checklist (PDF)

Notification of Pregnancy

A provider is required to promptly notify Carolina Complete Health when prenatal care is rendered. Early notification of pregnancy allows the health plan to assist the beneficiary with prenatal care coordination of services.

To notify CCH of pregnancy, please complete the Pregnancy Risk Screening Tool from NC DHHS available through the link below and fax to Carolina Complete Health Care Management Notification of Pregnancy: 833-417-0446. 

• NC DHHS Provider Forms: Reproductive Health Forms 
• For billing guidance on the Pregnancy Screening Tool, view the NC DHHS Medicaid Clinical Coverage Policy 1E-6: Pregnancy Management Program

A provider can also complete the NOP in the Secure Provider Portal under Assessments in the member's health record.

Review the Provider Guide for Pregnant Members (PDF) for additional support and resources!

Provider Guides

Getting Started

• Quick Reference Guide (QRG) (PDF)
• Secure Provider Portal Guide (PDF)
• Provider Portal Account Manager Guide (PDF)
• Prior Authorization Guide (PDF)

Claims, Billing, Coding

• Claims Submission Reminder Guide (PDF)
• 835 EDI Companion Guide (PDF)
• 837 EDI Companion Guide (PDF)
• 2022 AMA Coding Guidelines for Social Determinants of Health (PDF)
• Coordination of Benefits Entry Guide (PDF)

Reference Guides

• Accessing Your Payment Reports for Medical Home and Care Management PMPM (PDF)
• Converting your .TXT report files (PDF)
• Request to Move to NC Medicaid Direct or Local Management Entity-Managed Care Organization (LME-MCO) (PDF)
• How-To Guide: Finding Member’s Assigned PCP and the PCP’s Tier Status in the Provider Portal (PDF)
• Provider Tip Sheet for Pregnant Members (PDF)
• Provider Guide: Provider Enrollment and Data (PDF)
• PT/OT/ST Frequently Asked Questions Guide (PDF)