Special Bulletin

Important Integration Updates:

Carolina Complete Health

and WellCare of North Carolina

Dear Provider, 

Carolina Complete Health (CCH) and WellCare of North Carolina (WCNC) are uniting on April 1, 2026 as a state-wide Provider-Led Entity (PLE). The unified health plan will retain the name Carolina Complete Health.  

To support a smooth transition, Carolina Complete Health and WellCare of North Carolina are sharing provider information and guidance. This bulletin outlines changes that may impact your practice related to utilization management and procedural updates. 

Utilization Management Vendors 

Current and Future State 

To determine if prior authorization is required and to confirm where to submit the authorization, providers should use the Carolina Complete Health Pre-Auth Tool 

• https://www.carolinacompletehealth.com/providers/preauth-check/medicaid-pre-auth.html 

Additional details for the UM vendors are outlined below, including member populations impacted and the eligible scope(s) of service.  

EviCore 

• Launching no earlier than May 1, 2026 
• Member populations: Standard Plan Carolina Complete Health, Partners Tailored Plan Physical Health, Trillium Tailored Plan Physical Health  
• Eligible services: lab management for genetic testing. To check a specific procedure, use the Pre-Auth Tool. 
• Clinical Guidelines
• Provider Portal: https://www.evicore.com
• Phone: 1-888-333-8641 

Evolent 



• Launching April 1, 2026 for expanded services including Musculoskeletal Surgery and Interventional Pain Management. 
• Advanced Imaging will continue operating on 4/1/26 as it does today with Evolent. 
• Launching no earlier than May 1, 2026 for expanded services including Radiation Oncology. 
• Member populations: Standard Plan Carolina Complete Health, Partners Tailored Plan Physical Health, Trillium Tailored Plan Physical Health  
• Web resources: https://www1.radmd.com/all-health-plans/carolina-complete-health 
• Provider Portals: https://www.evolent.com/provider-portal 
• Rad Oncology: Utilize the CarePro Provider Portal 
• Advanced Imaging, MSK, and IPM utilize the RadMD™ Provider Portal 
• Phone: 1-800-424-4889  

TurningPoint 

• Launching no earlier than May 1, 2026 
• Member populations: Standard Plan Carolina Complete Health, Partners Tailored Plan Physical Health, Trillium Tailored Plan Physical Health 
• Eligible services include cardiovascular procedures in both the inpatient and outpatient setting. To check a specific procedure, use the Pre-Auth Tool. 
• Cardiac Ablation 
• Coronary Angioplasty/Stenting 
• Coronary Artery Bypass Grafting 
• Implantable Cardioverter Defibrillator 
• Internal Cardiac Monitoring 
• Left Atrial Appendage (LAA) Occluders 
• Non-Coronary Angioplasty/Stenting 
• Pacemaker 
• Peripheral Revascularization 
• Valve Replacement 
• WCD - Wearable Cardiac Defibrillator 
• Portal: http://www.myturningpoint-healthcare.com 
• Phone: 984-377-8573 | 855-909-5444 
• Fax: 833-986-1059 

Carolina Complete Health will continue to keep providers informed of new resources and trainings related to UM vendors through provider communications and the Carolina Complete Health Network website. 



Procedural Update Effective April 1, 2026 

Timely Filing for Claim Disputes 

• Carolina Complete Health Providers, please note for claims with dates of service 4/1/26 and after, contracted providers have 90 calendar days from the date of the Explanation of Payment (EOP) or Electronic Remittance Advice (ERA) to submit a claim dispute. Non-par providers have 60 calendar days from the EOP/ERA to submit a claim dispute. This was previously 365 calendar days for Carolina Complete Health providers. 

Please contact your Provider Relations representative with Carolina Complete Health or WellCare of North Carolina with any questions. Stay informed by bookmarking the Integration Provider Page which will be frequently updated with resources, trainings, and FAQs: https://network.carolinacompletehealth.com/merger.html