Tailored Plans

NCDHHS Delays Implementation of the NC Medicaid Managed Care Behavioral Health and I/DD Tailored Plans

To ensure beneficiaries can seamlessly receive care on day one, the North Carolina Department of Health and Human Services (NCDHHS) is delaying the implementation of the NC Medicaid Managed Care Behavioral Health and Intellectual/ Developmental Disabilities Tailored Plans (Tailored Plans) scheduled for Oct. 1, 2023, but will now go forward at a date still to be determined.

View more information in the NC DHHS Press Release.

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

Tailored Plans Provider Guide (PDF)

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 October 2023, NC Medicaid will no longer reimburse providers directly for physical health services rendered to Tailored Plan members.
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

For provider trainings related to Tailored Plans, visit our Education and Training page.

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.

Tailored Plan Provider Contracting Deadlines Questions and Answers (PDF) – An overview of frequently asked questions regarding providers and PHP’s during the contracting and auto- assignment process
Contracting with Tailored Plans (PDF) – An overview of key dates, reminders and links to assist providers and their beneficiaries before the Tailored Plan launch

For more, see the June 7th Medicaid Managed Care Provider Update

Frequently Asked Questions

If a provider is already contracted with CCH for Standard Plans, do they need to join the Tailored Plan to provide physical health services to TP members?

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.

If a practice currently does not have a contract with CCH and decides to contract for the Tailored Plan, will they then be able to see CCH patients under the Standard Plan?

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.