Tailored Plans

North Carolina continues to transition Medicaid from a fee-for-service delivery system to Managed Care. Tailored Plans are scheduled to launch in December 2022.

Carolina Complete Health is currently contracting providers for physical health for two Tailored Plans – Partners Health Management and Trillium Health Resources.

About Tailored Plans

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 65,000 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.

Important Dates and Information for Tailored Plan Contracting

When Tailored Plans launch in December 2022, 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 by 7/16/22 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 utilize our Tailored Plan Contract Request Form.

Tailored Plan Trainings

Tailored Plan 101: Ready, Set, Launch webinar series 

  • Sharing on behalf of NC DHHS and NC AHEC:
  • This webinar series occurs the third Thursday of each month at 5:30PM and is designed to support all Medicaid providers, practice managers, quality improvement professionals, care coordinators and other leaders within your practice to help you prepare for the launch. Register for the series.
  • Previous dates are recorded and available in the Archives section.

Tailored Care ManagementLearning Collaborative Sessions

  • Sharing on behalf of NC AHEC
  • The sessions are designed to provide content experts and peer-to-peer learning opportunities to AMH+ and CMA organizations as they prepare for TCM implementation and site reviews by the North Carolina Department of Health and Human Services. Sessions will continue every first and third Wednesday of the month from 12:30–1:30 PM.
  • Medicaid Managed Care Webinar Series for Providers | NC AHEC

Carolina Complete Health Network Information Sessions

  • Carolina Complete Health and Partners will host information sessions in August to educate providers about the upcoming launch of BH IDD Tailored Plans will launch on Dec. 1, 2022. 
    • Learn how to join the network or remain “in-network” for physical health services for Tailored
      Plan members.
    • Learn about upcoming milestones as we lead up to the launch of Tailored Plans on Dec. 1, 2022,
      including contracting deadline.
    • Q&A session with Network Teams from both CCH and Partners.
    • August 3rd: Recording and Slides (PDF)
    • Auguest 12th: Register

Tailored Plan Provider Resources

Sharing from NC DHHS:

The Provider Playbook is a collection of information and tools specifically designed to assist providers transitioning to NC Medicaid Managed Care. The latest resources are added to the fact sheet page.

Frequently Asked Questions

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 utilize our Tailored Plan Contract Request Form.

To be considered 'in-network’ and eligible for the full reimbursement rate for physical health services for Standard Plan members, providers should also be contracted with CCH for Standard Plan. Please see our Join the Network page for more information.