Guidance for Practice Managers on Navigating the 2026 Network Transition
Practice managers should be fully prepared for the substantial changes coming to the North Carolina State Health Plan (NCSHP) network in 2026. The Plan is facing a $507 million deficit, prompting a thorough evaluation of existing programs and reimbursement models. Sincere gratitude is extended to all organizations that have supported both the Plan and its members during these times. This post outlines what’s changing, why, and what practical steps your practice may need to take.
Clear Pricing Project (CPP) Ending December 2025
The Clear Pricing Project (CPP), launched in 2020, promoted transparent healthcare pricing and aimed to incentivize quality primary and behavioral health care by offering zero copays to members who visited participating providers. While this model brought increased reimbursement rates for many providers, it has not been financially sustainable. As a result, CPP will conclude on December 31, 2025. After that point, providers will no longer receive current elevated reimbursement rates, and members will not have a $0 copay structure for behavioral health services.
Preferred Providers: New Structure in 2026
Effective in 2026, the State Health Plan will roll out the Preferred Provider initiative. The only way for practices to become Preferred Providers will be through affiliation with CCPN (Community Care Physician Network), Aledade, or The Alliance. Practices outside these partnerships will still be considered in-network, but cost shares for members will be different—typically higher than those for Preferred Providers.
Key Action: Review your current affiliations and consider whether joining CCPN, Aledade, or The Alliance is right for your practice. Preferred Providers will grant patients access to lower copays starting in 2026.
Behavioral Health Access Program (BHAP)
To continue supporting behavioral health, the Plan is launching the Behavioral Health Access Program (BHAP) in 2026. This program creates a custom fee schedule for behavioral health providers, specialties, and a specific set of CPT codes:
- 140% of current NC Medicare rates (updated annually, effective May 1) for key codes: psychotherapy, evaluation & management, psychological testing
- ABA services reimbursed at NC Medicaid rates
- TMS codes reimbursed at Aetna Market Fee Schedule (AMFS) rates (same as current CPP)
Action for Behavioral Health Practices: If interested in joining BHAP, visit the Aetna website for enrollment details and next steps.
Working with Aetna: Network Participation & Resources
Aetna will serve as the third-party administrator for the Plan starting January 2026. Practices must be part of Aetna’s Choice POS II network to remain in-network for State Health Plan patients. If not already participating, please visit the Aetna website to begin the enrollment process.
Additional Resources for Practice Managers:
- 2025 NCSHP Network Participation Agreement (Aetna)
- 2025 NCSHP Network Rate Schedule (Aetna)
- 2025 NCSHP Network Professional Fee Schedule (Aetna)
- Aetna Provider Website
- Signup for Aetna emails
- OfficeLinks Updates Newsletters
- Aetna Provider State Health Plan site
- Aetna Resources
For contract, reimbursement, or benefits questions, contact Aetna Provider Line at 888-632-3862. For clinical or precertification information, refer to Aetna’s clinical information and prior review resources. Email NorthCarolinaNetwork@aetna.com for network queries, or SHPProviderNetwork@nctreasurer.com for State Health Plan questions.
What Practice Managers Should Do Now
- Evaluate providers’ current affiliations and consider joining CCPN, Aledade, or The Alliance for Preferred Provider status.
- For behavioral health, review the BHAP program and assess if it matches the needs of your practice.
- Ensure participation in Aetna’s Choice POS II network before January 2026 to maintain in-network status.
- Stay updated on policy changes, copay and reimbursement structures, and communicate these changes to your team and patients.
North Carolina needs primary care clinicians to support the state’s rapidly growing population, and the Primary Care Clinician Index from the Sheps Center tracks changes in the healthcare workforce. This recent article in the NC Medical Journal discusses the changes that this index shows in the NC healthcare workforce, highlighting the statewide patterns in clinician location and type.
As North Carolina moves into data-driven, value-based health care, the N.C. Health Information Exchange Authority is working to modernize the state-designated health information exchange, NC HealthConnex. This valuable tool can help your practice close important care gaps through information exchange between health care provider and patient. The N.C. Health Information Exchange Authority is offering valuable training on the features of NC HealthConnex.
