Carolina Complete Health NC Medicaid: Behavioral Health Billing Guide
Carolina Complete Health shows up in North Carolina billing in two ways. It is a Standard Plan in its own right, and Carolina Complete Health Network also publishes provider resources for some Tailored Plan members. Knowing which role a claim falls under is the first question.
Short answer
Carolina Complete Health is an NC Medicaid Standard Plan. Behavioral health authorizations can be requested through the Secure Provider Portal at provider.carolinacompletehealth.com, by phone, or by fax, and its Pre-Auth Check Tool shows whether a service needs authorization. As a Standard Plan it does not cover (b)(3) services, and services from the Innovations waiver are not covered under the Standard Plan.
Where Carolina Complete Health fits
Carolina Complete Health is one of North Carolina's Standard Plans, which cover most NC Medicaid members with physical and behavioral health together. Members with significant behavioral health, substance use, I/DD, or TBI needs are served by Tailored Plans instead, so confirm the member's plan in NCTracks before assuming Standard Plan rules apply.
Authorization and the portal
Use the Pre-Auth Check Tool to see whether a specific service needs authorization. Behavioral health authorizations can be requested through the Secure Provider Portal, by phone, or by fax. The portal also tracks prior authorizations, claim submissions and status, and payment history. Registration is free through your provider network specialist.
What the Standard Plan does not cover
Carolina Complete Health notes that Standard Plans do not cover (b)(3) services, and that Innovations waiver services are not covered under the Standard Plan. Those belong to Tailored Plans, so a claim for them under Carolina Complete Health's Standard Plan will not pay.
Its role in Tailored Plans
Carolina Complete Health Network also publishes provider resources for Partners and Trillium Tailored Plan members. If a member is in a Tailored Plan, follow that plan's routing; see Partners and Trillium.
Where behavioral health claims go wrong
- (b)(3) or Innovations services under the Standard Plan. Services that belong to a Tailored Plan billed to the Standard Plan.
- Skipping the Pre-Auth Check Tool. Services that need authorization billed without it.
- Wrong role. A Tailored Plan member's claim handled as a Standard Plan claim.
Related: verifying NC Medicaid eligibility in NCTracks, associate-level clinician billing in NC, and the NC Medicaid behavioral health billing guide.
Sources, checked October 2026: Carolina Complete Health prior authorization; Partners Tailored Plan provider resources. Confirm current details on the plan's provider site.
Frequently asked questions
Does Carolina Complete Health require prior authorization for behavioral health?
For some services. Use the Pre-Auth Check Tool to check a specific service; authorizations can be requested through the Secure Provider Portal, by phone, or by fax.
What is the Carolina Complete Health provider portal?
The Secure Provider Portal at provider.carolinacompletehealth.com, for prior authorizations, claim submissions and status, and payment history.
Does Carolina Complete Health cover (b)(3) services?
Not under its Standard Plan. Standard Plans do not cover (b)(3) services, and Innovations waiver services are not covered under the Standard Plan.
Is Carolina Complete Health involved in Tailored Plans?
Carolina Complete Health Network publishes provider resources for Partners and Trillium Tailored Plan members. Follow the Tailored Plan's own routing for those members.
The right plan, the right role.
See Stable check whether a service belongs to the Standard Plan or a Tailored Plan before the claim goes out.
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