Carolina Complete Health is a Medicaid Managed Care provider-led health plan in North Carolina.
Carolina Complete Health is a joint venture collaboration between the North Carolina Medical Society (NCMS) and Centene Corporation, a Fortune 50 business with over 30 years of expertise in managed care systems, working together with the North Carolina Community Health Center Association (NCCHCA).
North Carolina Medical Society (NCMS) (NCMS)
The NCMS is the oldest professional member organization in North Carolina, serving doctors and physician assistants who operate in the state.
Founded in 1849, the Society strives to encourage access to excellent health care for all residents in North Carolina and advocates projects that attempt to enhance the quality of treatment and promote patient safety.
North Carolina Community Health Center Association (NCCHCA)
The NCCHCA is a private, non-profit membership group representing federally-qualified health centers and aspiring health centers in North Carolina.
Among the goals of the NCCHCA is to help its members’ patient-governed community health care organizations and the people they serve to grow and thrive.
Centene Corporation began in Wisconsin in 1984 as one health plan to better serve the underinsured and uninsured.
Today, Centene is a multi-national healthcare company that offers a wide range of services to government-sponsored healthcare programs.
Centene operates over 24 million members via locally-operated health plans in more than two dozen states and provides a comprehensive spectrum of health insurance alternatives.
It also contracts with other healthcare and business entities to deliver specialized services.
The Carolina Complete Health Difference
Provider-led and community-based, Carolina Complete Health is an affordable health plan for North Carolina’s residents that improves their quality of life while saving the state money.
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Carolina Complete Health Provider Portal
Please become a member of our online community now. Free and simple!
As a patient, you will be able to see all of your medical records. View your claims, get a new ID card, and more!
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LTSS, community benefits, and physical and mental health care are part of Carolina Complete Health’s scope of services.
Program eligibility is based on your age, income, family size, and any specific health requirements that you may have.
Contact us if you don’t know what program you’re in. We’re here to assist!
Carolina Complete Health benefits
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Does Carolina Complete Health cover dental
For families and individuals in our coverage locations in North Carolina, Carolina Complete Health provides a wide range of comprehensive health insurance plans that meet their requirements. Carolina Complete Health’s services and perks are listed below.
When medically required, Carolina Complete Health may pay for services or locations that North Carolina Medicaid doesn’t cover instead of such services.
Check the Member Handbook for a comprehensive list of perks and services that you are entitled to receive.
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What is Carolina Complete Health?
Pregnant women, families with children, the elderly, people with disabilities, and children with disabilities in Regions 3, 4, and 5 are covered by Carolina Complete Health; a Medicaid Managed Care health plan headed by providers. View the coverage map for Carolina Complete Health.
What Exactly Is An MCO (Managed Care Organization)?
A managed care organization (MCO) is a health insurance carrier that works with medical facilities and providers to deliver services to its customers.
Carolina Complete Health Covers What?
In addition to medical care, Carolina Complete Health’s benefits include coverage for preventative services, prescription medication coverage, and more.
The Member Handbook, available online, provides a complete list of benefits, and Value-Added Services are also available to Carolina Complete Health members.
Which People May Be Eligible?
To qualify for Medicaid, applicants must also fulfill various other conditions. The Department of Health and Human Services determines eligibility for programs and services (DHHS).
The DHHS Contact Center may be reached at 1-800-662-7030 if you have any North Carolina Medicaid eligibility questions.
Do I have to pay anything to be enrolled in Carolina Complete Health?
No. Carolina Complete Health has no enrollment fees. Copayments for provider/doctor appointments, emergency room treatment, and medications may be relatively low for specific members.
What is the procedure for applying for assistance?
A variety of methods are available for submitting a request.
At 1-800-662-7030, call the DHHS Contact Center.
Online: Use the North Carolina DHHS Services Portal to apply.
Paper Application (PDF): To submit a paper application, click here.
Will I have to make any changes to my Medicare plan due to enrolling in Carolina Complete Health if I have both Medicare and Medicaid?
No. Your Medicare benefits and doctors/providers will not change despite the new law. Coordinating services between your Medicaid Managed Care Organization (MCO) and Medicare Primary Care Provider/Doctor is the duty of your MCO.
How Do I Find Out if My Doctors Are Part of a North Carolina Medicaid Managed Care Organization (MCO)?
Please consult with your healthcare professionals to see whether they are part of the Carolina Complete Health network.
Find a Provider on our website has a Doctor/Provider Directory, or you may reference our Provider Directory to find a doctor/provider in your area.
Contact Carolina Complete Health Member Services at 1-833-552-3876 if you have concerns regarding our physicians (TTY: 711).
Is it possible for me to switch primary care doctors?
Yes. You are free to change your primary care provider/doctor at any moment.
To Make an Appointment, What Do I Do?
In-network specialists don’t require a referral from your primary care physician, but your primary care provider must be aware of any specialists you see so they have a complete picture of your health and help you coordinate treatment.
Carolina Complete Health Member Services may be reached at 1-833-552-3876 if you have any questions (TTY: 711).
What’s the community benefit?
These programs are referred to as “Community Benefits,” They aim to maintain residents in their homes and neighborhoods. Adult day health, respite care, and personal care are offered.