^{NC Medicaid}

NC Medicaid Managed Care Transformation efforts continue. Standard Plans went live July 1, 2021, while Behavioral Health I/DD Tailored Plans implementation is currently scheduled for July 1, 2024.

Background:

In 2015, the NC General Assembly directed the transition of Medicaid to a privatized managed care structure. For the first time in NC Medicaid history, we will have an integration of behavioral health and physical health reimbursement dollars. In February 2019, NC DHHS announced the four entities who have received contracts to participate as Prepaid Health Plans (PHPs) in Medicaid Managed Care:

1. AmeriHealth Caritas North Carolina, Inc.
2. Blue Cross and Blue Shield of North Carolina
3. UnitedHealthcare of North Carolina, Inc.
4. WellCare of North Carolina, Inc.

A regional contract for Regions 3 and 5 was awarded to Carolina Complete Health, Inc.

Quicklinks to Plan Resources:

NC DHHS | AmeriHealth Caritas | Carolina Complete Health | Healthy Blue | United Healthcare | WellCare

Psychiatrists can and should enroll with both the Standard Plans and Tailored Plans.

Standard Plans

The Standard Plans will cover "mild to moderate" mental illnesses in the Medicaid population, and psychiatrists will be included in the networks to help take care of these patients. These plans are required to accept "any willing provider" who meets quality standards and accepts the Plan reimbursement rate. 

NC DHHS is requiring that all of the Plans use the NC DHHS credentialing and enrollment system, a single statewide formulary to streamline the process.  Back to top

Resources:

NC DHHS

For more information on Medicaid Transformation developments, visit the NC DHHS website.

• Provider Ombudsman:
  • [email protected]
  • 866-304-7062
• Practice Support and Technical Assistance:
  • NC AHEC
  • [email protected]
• FAQ Page
• Fee Schedules
• Trainings
• NCTracks
• Transitions of Care

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AmeriHealth Caritas

Provider Support Number:  888-738-0004

• Provider Manual (PDF)
• Provider Billing Manual (PDF)
• Quick Reference Guide (PDF)
• Behavioral Health Toolkit (PDF)
• AHC Clinical Policies Page

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Carolina Complete Health

Provider Support Number:  833-552-3876
Behavioral Health Medical Director: Nena Lekwauwa, MD

• 2021 Provider Manual (PDF)
• CCH 2021 Provider Billing Manual (PDF)
• Quick Reference Guide (PDF)
• Behavioral Health Webpage with Toolkits Page
• CCH Clinical Policies Page

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Healthy Blue

Provider Support: 844-594-5072
Behavioral Health Medical Director: Steve Bentsen, MD

• Provider Manual (PDF)
• Quick Reference Guide (PDF)
• Behavioral Health Orientation (PDF)
• Healthy Blue Clinical Policy Info Page

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United Healthcare

Provider Support: 800-638-3302
Behavioral Health Medical Director: Stephanie Exum, MD

• UHC Community Plan Provider Manual (PDF)
• UHC Quick Reference Guide (PDF)
• Behavioral Health Page
• Behavioral Health Toolkits Page

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WellCare

Provider Support:  866-799-5318
Behavioral Health Medical Director: Therese Garrett, MD

• Provider Resource Page
• WellCare Quick Reference Guide
• Behavioral Health Page
• WellCare Clinical Policies Page

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Transformation of the Current LME/MCO System and Tailored Plans

The current LME/MCO systems will remain in place but will be redesigned as Tailored Plans. Patients with IDD and more serious mental illness and addictions will continue to get their mental health care and enhanced services in the current LME/MCO system. 

Tailored Plans will remain regional and they will be able to close their provider panels as needed. Tailored Plans will cover all the behavioral health services covered by the Standard Plans but will also exclusively cover some enhanced behavioral health services (such as Intensive In-Home, ACT, and Residential SUD treatment).

Resources:

NCDHHS Training Resources

Recorded NC Medicaid Training Courses

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