North Carolina Medicaid is entering a major new chapter. Carolina Complete Health (CCH) and WellCare of North Carolina will officially merge into a single statewide health plan on April 1, 2026. The new combined plan will operate under the Carolina Complete Health name and will serve all six NC Medicaid regions.

As your Northwest AHEC Practice Support Team, we’re here to break down what this means for your practice, your teams, and—most importantly—the North Carolinians you care for.

Why This Merger Matters

This transition creates North Carolina’s largest Medicaid health plan, covering more than 775,000 members across the state. The unified plan continues as a Provider-Led Entity (PLE)—meaning North Carolina physicians retain a central governance role.

For practices, this means:

• Continued emphasis on provider voice in decision-making
• Streamlined processes under one statewide plan
• Reduced administrative duplication across CCH and WellCare products

Key Implementation Details You Need to Know

📅 Effective Date

April 1, 2026, unless NC DHHS issues updated guidance.

What This Means for Your Medicaid Patients

For current WellCare members

• Automatically transitioned to Carolina Complete Health
• No change in Medicaid benefits
• Will receive a new Member Welcome Packet and Member ID card
• Most members will keep their current primary care provider

For current Carolina Complete Health members

• Coverage expands statewide from 3 to 6 regions
• No change in Medicaid benefits
• New CCH Member ID card will be mailed as part of annual re-card
• Patients may keep their existing PCP

For Non-Members

Carolina Complete Health offers a free solution for payment by Electronic Funds Transfer (EFT) and Electronic Remittance Advice (835)/Explanation of Payment (ERA/EOP) through PaySpan®. If you are not already registered, create a new account by registering at payspanhealth.com or calling 1-877-331-7154, option 1.

For CCH providers

 The public website will remain https://network.carolinacompletehealth.com/. WellCare providers should begin using this webpage upon go-live (anticipated to be 4/1/2026) for updated materials (i.e. provider and billing manuals, contacts, and provider tools). 

What This Means for Your Practice

1. Contracting & Network Participation

• If your practice is contracted with either CCH or WellCare, you will remain contracted with the merged entity.
• To eliminate redundancy, the Medicaid product under WellCare agreements will be terminated as of April 1, 2026.
• Providers will continue serving:
  • Medicaid & Tailored Plan members through the CCH agreement
  • Medicare members through the WellCare agreement

If you received termination notices tied to the Medicaid product, these apply only to the WellCare Medicaid portion—not your overall WellCare contract.

2. Member Reassignment & Market Share

CCH has clarified:

• The new entity is not expected to exceed the market share cap
• Providers should not see large-scale member panel reassignment due to the merger

3. Billing, Claims & EFT/ERA

Frequently asked questions from providers include:

• EFT/ERA services will continue uninterrupted
• Claims for dates of service before April 1, 2026 will follow the originating agreement (CCH or WellCare)
• Claims on or after April 1, 2026 will process under the new CCH statewide plan

Updated provider manuals, billing guidance, and operations details will be posted on the official merger site as the go-live date approaches.

Operational Steps You Should Take Now

✔ Verify provider directory listings

Ensure your practice’s information is correct across:

• CCH Provider Directory
• WellCare Provider Directory

✔ Educate front‑desk and billing teams

Key items to emphasize:

• New member ID cards
• How to verify eligibility during the transition
• Which plan to bill based on date of service

✔ Review your contracts

Look specifically for:

• CCH agreement terms
• Any Medicaid-product termination notices from WellCare
• Tailored Plan participation details (if applicable)

✔ Monitor value-added service changes

Both CCH and WellCare note modifications coming to value-added services for 2026.

What Stays the Same

• Medicaid benefits for members
• Primary care provider assignments
• Commitment to provider-led governance
• NC Medical Society and NC Community Health Center Association remain partial owners of the Provider Led Entity (PLE)

Resources for Practice Managers

Here are the most relevant resources for keeping your team prepared:

Provider Merger FAQ (CCH Network Site)
https://network.carolinacompletehealth.com/merger.html

Member Merger Information (Public Site)
https://www.carolinacompletehealth.com/merger.html

Provider Services Contact:
1‑833‑552‑3876
NetworkRelations@CCH-Network.com

We’re excited to share a new opportunity from SEAHEC: the Healthcare Mastery Series, a free three-part learning experience designed to strengthen your front office operations and clinical documentation practices.

This series offers practical tools and expert-led insights on:

• Front Office Professional– June 11 at 12 PM
• Point of Service Collections– June 18 at 12 PM
• Coding and Documentation: Revised Guidelines for Office and Hospital Evaluation and Management Coding– July 16 at 12 PM

Each session is a FREE, one hour and tailored to help your team enhance patient engagement, streamline workflows, and stay current with evolving standards in healthcare delivery. 

You can register for any or all of the webinars.

For more details, see the brochure HERE. 

Starting October 1, 2024, the Centers for Medicare and Medicaid Services incorrectly returned certain Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) claims with reason code W7072:

• Type of bill: 017X (RHC) and 077X (FQHC)
• HCPCS code 93010 (electrocardiogram, EKG or ECG)

RHCs and FQHCs should resubmit these claims that were returned in error.

Tailored Plans are set to launch on July 1, 2024. As a provider of physical health services, you and your teams need to know how and where to submit claims for payment of services rendered. 

Did you know?

The typical primary care physician caring for Medicare patients must coordinate care with 229 other physicians working in 117 practices?

The 2024 Final Rule from CMS (Center for Medicare and Medicaid Services) established a new code to ensure Primary Care Providers receive additional payment for the high-value visits they provide.

Provider Relief Fund (PRF) recipients who received one or more payments exceeding, in the aggregate, $10,000 during a Payment Received Period are required to report as part of the post-payment reporting process. The reporting portal is now open. If you received payments from the fund between April and June 2020 you are required to report prior to September 30th, 2021. 

In an effort to improve healthcare quality and reduce costs, many states and healthcare plans are adoption Value-based payments. These financial levers are being used to encourage AUD/SUD treatment in primary care settings. This program is designed to give you an understanding of how to apply harm reduction strategies for AUD/SUD in primary care setting, including quick interventions and next steps if patients are deemed in need of immediate intervention-crisis.

In an effort to ensure optimal access to care for Medicaid beneficiaries, to support providers during the recent COVID-19 surge, and to alleviate potential provider payment concerns, DHHS and the prepaid health plans (PHPs) have agreed to extend the policy for out of network flexibilities to providers who have not yet contacted with a PHP through Nov. 30, 2021. These flexibilities were originally expected to sunset on Aug. 30, 2021.   

What is the Request to Move to NC Medicaid Direct Process? 

In the April 2021 Medicare Secondary Payer MLN Booklet, CMS clarified the policy on accepting payments for services when another insurance is primary to Medicare. 

To learn more about Medicare Secondary Payer(MSP) billing and claims review the Medicare Secondary Payer MLN Booklet.  Common MSP coverage situations are listed in Table 1 (pp 5-8).