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Approved PHP Provider Contract Templates as of June 21, 2019

Monday, July 1, 2019

The Contract for Prepaid Health Plan Services (the State Contract) between the Department of Health and Human Services (the Department) and the selected Medicaid Managed Care plans (i.e., Prepaid Health Plans or PHPs) indicates that contracts between PHPs and providers shall comply with the terms of the State Contract and must be approved by the Department.

The Department announces the approval of the following provider contract templates:

PHP Name

Contract/Document Name

Date of Approval

United HealthCare of North Carolina, Inc.

Ancillary Provider Participation Agreement

6/21/19

United HealthCare of North Carolina, Inc.

Facility Participation Agreement

6/21/19

United HealthCare of North Carolina, Inc.

[FQHC]/[RHC]/[IHCP] Participation Agreement

6/21/19

United HealthCare of North Carolina, Inc.

Medical Group Participation Agreement - Medicaid Only Option

6/21/19

United HealthCare of North Carolina, Inc.

Facility Participation Agreement - Medicaid Only Option

6/21/19

United HealthCare of North Carolina, Inc.

Single Practitioner Participation Agreement - Medicaid Only Option

6/21/19

United HealthCare of North Carolina, Inc.

Small Medical Group Participation Agreement

6/20/19

United HealthCare of North Carolina, Inc.

Provider Organization Participation Opt In Agreement

6/20/19

United HealthCare of North Carolina, Inc.

Provider Organization Participation Agreement

6/20/19

United HealthCare of North Carolina, Inc.

Single Physician/Practitioner Participation Agreement

6/20/19

United HealthCare of North Carolina, Inc.

Practitioner Group Participation Agreement

6/20/19

United HealthCare of North Carolina, Inc.

Medical Group Participation Agreement

6/20/19

AmeriHealth Caritas North Carolina, Inc.

Health System Provider Agreement

6/19/19

Carolina Complete Health, Inc.

Participating Provider Agreement for Individual Practitioner

6/17/19

WellCare of North Carolina, Inc.

Participating Provider Agreement - IHCP

6/14/19

AmeriHealth Caritas North Carolina, Inc.

Ancillary Services Agreement

6/10/19

WellCare of North Carolina, Inc.

Participating Provider Agreement – AMH

6/10/19

WellCare of North Carolina, Inc.

Participating Provider Agreement – LHD

6/10/19

AmeriHealth Caritas North Carolina, Inc.

Hospital Services Agreement

6/4/19

AmeriHealth Caritas North Carolina, Inc.

Physician Provider Agreement

6/4/19

AmeriHealth Caritas North Carolina, Inc.

Provider Agreement Addendum - Tier 3 AMH

6/4/19

AmeriHealth Caritas North Carolina, Inc.

Provider Agreement Addendum - LHD CM for At-Risk Children

6/4/19

AmeriHealth Caritas North Carolina, Inc.

Provider Agreement Addendum - LHD CM for High-Risk Pregnancy

6/4/19

WellCare of North Carolina, Inc.

Participating Provider Agreement for Facility Providers

6/4/19

WellCare of North Carolina, Inc.

Services Agreement - Home and Community Based Services

6/4/19

WellCare of North Carolina, Inc.

Participating Provider Agreement - Provider System

6/4/19

WellCare of North Carolina, Inc.

Participating Provider Agreement - Hospital

6/4/19

WellCare of North Carolina, Inc.

Participating Provider Agreement - Professional

6/4/19

Blue Cross Blue Shield of North Carolina/Healthy Blue

Medicaid Provider Agreement for all provider types

5/29/19

Carolina Complete Health, Inc.

Participating Provider Agreement for Facility Providers

5/29/19

The Department is continuing to review other Provider contracts for PHPs. As the Department approves other provider contract templates, the Department will update this list and issue updated notices.

PHPs are permitted to utilize draft Provider contract templates until the Department approves the templates. Providers who are considering contracting with a PHP or who are in contract negotiations with a PHP should discuss with the PHP how to access the approved contract templates.

Providers wishing to discuss contracting with a PHP or obtain a copy of an approved contract template will find contact information for the PHPs here:  https://medicaid.ncdhhs.gov/health-plan-contact-information

In accordance with Section 5.(6)d. of Session Law 2015-245, except as otherwise allowed under the State Contract, a PHP shall not exclude eligible providers from its network except when a provider fails to meet the PHP’s Objective Quality Standards or refuses to accept network rates (which shall not be lower than any applicable rate floors).

Author: 
Medicaid.Transformation@dhhs.nc.gov