Carolina Complete Health and WellCare Vendors List

Legal Name of Contractor and name used for business	Description of Services Provided by Subcontractor
Advanced Medical Review	UM Initial Reviews, Determinations, Appeals
Availity	A portal service for Centene that facilitates various functions such as CQV data configurations, Daily Care Gaps, EDI connectivity for Panel Rosters and ADT notifications. Includes the Availity Essentials Provider Engagement Portal, which supports authorization submissions, claims status checks and checks for member eligibility and benefits.
BHM Healthcare Solutions	UM Initial Reviews, Determinations, Appeals
C3/CustomerContactChannels, Inc. d/b/a Everise	Member and Provider Customer Service; Offline and Backoffice support
CareCore National, LLC d/b/a eviCore	UM Initial Reviews, Determinations, Appeals for Genetic Testing and Complex Labs
Centene Management Company, LLC (affiliate)	Claims administration, customer service, utilization management, finance support including actuarial support, provider data management and fraud, waste and abuse support. 24/7 Nurse Advice Line services Disease Management and Health Coaching Online Health Content
Centene Vision, Inc. (affiliate)	Vision claims processing and payment
Carolina Complete Health Network	Network Development & Contracting Provider Relations Provider Education
Express Scripts International, Inc	Pharmacy Benefit Management Pharmacy Network Contracting Pharmacy Network Management Pharmacy Rebate Administration Administer Preferred Drug List (PDL) Pharmacy claims processing and payment Pharmacy provider call center services
Evolent Health, Inc	Utilization review and prior authorization of certain services including, but not limited to, radiology, cardiac imaging, radiation oncology and interventional pain management
Focus Health	UM Initial Reviews, Determinations, Appeals
Healthmap	Care Management Health Assessments
Homecare Software Solutions, LLC aka HHAexchange	Electronic visit verification of Personal Care Services to ensure services are delivered as authorized to enrollees Home Health Services
Icario (fka Healthtel/Revel Health, LLC)	Conducts inbound and outbound member communication related to specific programs
Medical Review Institute of America (MRIoA)	Provides recommendation on utilization management cases and physician reviewer extenders
Medical Transportation Management, Inc.	Non-emergency Medical Transportation
NTT Data	Provides services and staff related to benefit configuration and claims adjudication
Partners Behavioral Health Management	24/7 Behavioral Health Nurse Crisis Line
RVO Health	Tobacco Cessation (Quit for Life Program) and Nicotine Replacement Therapy (NRT) services for members
Signify Health	Provides virtual and in-home Health Risk Assessment services for members
Teleperformance (TPUSA)	Provides call center services for Centene's pharmacy operations, handling inquiries from members, providers and pharmacies about prescriptions, coverage and costs
The Results Company, LLC	Provides contact center services
TurningPoint Healthcare Solutions, LLC	UM Vendor that performs reviews on certain cardiology procedures

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This page was last modified on 02/19/2026