Manual, Forms, and Guides

Provider Manuals

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

Provider Forms

• Provider Claim Complaint/Appeal Form (PDF)
• Prior Authorization Form (PDF)
  • Prior Authorization Tip Sheet (PDF)
  • Behavioral Health UM Prior Authorization Guidelines (PDF)
    
  • For Behavioral Health, please see state bulletin regarding COVID-19 flexibilities for specifics related to BH prior authorizations.
  • Applied Behavioral Analysis Outpatient Treatment Request Checklist (PDF)
• Personal Care Services Request Form 
  • The beneficiary shall be referred to PCS by his or her primary care practitioner or attending physician utilizing the 3051 Physician Referral form. Upon completion, fax to Carolina Complete Health Care Management: 833-238-7689
• Primary Care Provider (PCP) Change Fax Form (PDF)
• Notice of Pregnancy Form (PDF)

Provider Guides

• Quick Reference Guide (QRG) (PDF)
• Secure Provider Portal Guide (PDF)
• Provider Portal Account Manager Guide (PDF)
• Prior Authorization Guide (PDF)
• Claims Submission Reminder Guide (PDF)
• 835 EDI Companion Guide (PDF)
• 837 EDI Companion Guide (PDF)
• How-to Guide: Accessing Your Payment Reports for Medical Home and Care Management PMPM (PDF)
  • How-to Guide: Converting your .TXT report files (PDF)
• 2022 AMA Coding Guidelines for Social Determinants of Health (PDF)