Information for Tailored Care Management Providers

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This page has technical information for providers of Tailored Care Managment.

Not a provider? Visit Tailored Care Management instead.

About the Tailored Care Management model

The Tailored Care Management (TCM) model reflects the goal of whole-person care management in NC Medicaid Managed Care. Provider-based care management promotes integrated care and offers members a choice in how they receive care management.

Through TCM, members have a single designated Tailored Care Manager supported by a care team to provide care management that addresses all of their needs including physical health, behavioral health, intellectual/developmental disabilities (I/DD), traumatic brain injuries (TBI), pharmacy, long term services and supports (LTSS) and unmet health-related resource needs.

TCM will:

  • Be available throughout the entire duration of a member’s enrollment in a Tailored Plan or NC Medicaid Direct.
  • Be based in provider settings to the maximum extent possible, supporting integrated care and collaboration.
  • Prioritize frequent in-person interactions between Tailored Care Managers and members.
  • Place additional emphasis on outcomes and population health management.

Local Management Entity/Managed Care Organizations (LME/MCOs) and TCM providers began providing TCM Dec. 1, 2022.

Effective, integrated and well-coordinated care management depends on care team members having the ability to efficiently exchange member health information and use that information to monitor and respond to medical and nonmedical issues that could impact members.

The success of TCM will depend upon Tailored Plans, Advanced Medical Home Plus (AMH+) practices, Care Management Agencies (CMAs), pharmacies, and physical health, behavioral health and I/DD providers using a coordinated approach to member care.

For an overview of Tailored Care Management, go to the page for members.

Application Period Open for Round 4 Tailored Care Management Certification

A key area of focus in Medicaid Transformation is building robust and effective models for supporting beneficiaries’ whole person care needs through local care management.

To help meet the needs in the Tailored Plan regions, the Round 4 application period for AMH Tier Three practices seeking Tailored Care Management (TCM) Certification is open July 15 through Sept. 1, 2025. The certification process will be conducted by the State’s certification vendor, NCQA, using the Tailored Care Management model requirements.

The documentation to establish eligibility obtained from the Tailored Plan along with your Notification of Intent to Participate must be submitted between July 15 and Sept. 1, 2025.

Minimum Eligibility Requirements

Active AMH Tier 3 Practice

AMH practice serves at least 100 active Medicaid patients who have an SMI, SED or severe SUD; an I/DD; or a TBI. “Active” patients are those with at least two encounters with the AMH+ applicant’s practice team in the past 18 months.

Process to Request Verification

AMH+ practices should contact the Tailored Plans in the region where their practices are located. Please reach out to the Tailored Plan your practice intends to contract with to validate your organization’s TCM eligibility.

Appropriate Point of Contact Email from Tailored Plan

Once your organization and the Tailored Plan are ready to complete the Verification Form, please follow the steps below:

Step 1: Email NCQA at nctailoredcaremgmt@ncqa.org and provide the following information:

  • Name of Your Organization

  • Name of Tailored Plan

  • Number of Sites for which you are seeking AMH+ Certification

Step 2: Within 3 business days, NCQA will send back the Verification Form via Adobe Acrobat Sign for your organization and the Tailored Plan to complete.

Step 3: Complete your assigned fields and sign the form. Please note that a separate page must be completed for each site for which you are seeking AMH+ certification on the Verification Form. Signatures are only required for pages that include practice information.

Step 4: Once the form is signed, the PDF will be sent directly to the Tailored Plan Point of Contact for their approval and signatures. After the form is signed by both parties, your organization and the Tailored Plan will both receive fully executed versions of the Verification Form.

Step 5: Once your organization has received the Verification Form, complete the Notification of Intent to Participate in Round 4 Smartsheet form, where you will be required to submit the fully executed Verification Form to NCQA.

Process After Verification

Practices that meet the minimum eligibility requirements will receive a login to submit their TCM Desk Review Application on or after Sept. 15, 2025. Applicants should review the TCM Provider Manual, which describes the care management model, outlines TCM requirements, and offers guidance on the certification process.

Tab/Accordion Items

Archive

Tab/Accordion Items

Webinar: Transition to Tailored Care Management for Children/Youth Served by the Child Welfare System:
A Resource for County DSS and Other Stakeholders - Nov. 29, 2022

Tailored Care Management Technical Support Educational Series

 
Tailored Care Management Certification Webinar – Thursday, Dec. 17, 2020
 
This webinar walks through the certification process for AMH+ practices and CMAs looking to deliver services through the Tailored Care Management model.

Tailored Care Management: What Providers Need to Know - Dec. 18, 2019

Care Management under the Behavioral Health I/DD Tailored Plan - August 30, 2019

Behavioral Health I/DD Tailored Plan Care Management - August 20, 2019

Behavioral Health I/DD Tailored Plan Care Management - May 30, 2019

Integration of Behavioral and Physical Health Care in Tailored Plan - Jan. 24, 2019

Temporary Flexibilities and Program Changes

The Tailored Care Management program launched on December 1, 2022. Recognizing that it would take providers some time to ramp up and meet the full set of program requirements, on November 2, 2022,  the Department released a memo permitting temporary flexibilities and program changes for the period between December 1, 2023, and March 31, 2023. The majority of these flexibilities came to an end on March 31, 2023, and some will continue until June 30, 2023. This memo seeks to clarify the current status of each flexibility and outlines several additional program updates.

NOTE: Until Tailored Plan launch, the State’s local management entity/managed care organizations (LME/MCOs) will continue to operate the Tailored Care Management model. Individuals eligible for the model will still have the option to obtain Tailored Care Management from an Advanced Medical Home Plus (AMH+) practice, Care Management Agency (CMA), or plan-based care manager. Until an eligible individual engages in Tailored Care Management, their LME/MCO will be responsible for care coordination functions. In the future, Tailored Care Management will be offered by LME/MCOs in their role as both Tailored Plans and prepaid inpatient health plans (PIHPs).

To ensure beneficiaries can seamlessly receive care on day one, the North Carolina Department of Health and Human Services (NCDHHS) is delaying the implementation of the NC Medicaid Managed Care Behavioral Health and Intellectual/ Developmental Disabilities Tailored Plans (Tailored Plans), now scheduled for July 1, 2024. Beneficiaries who will be covered by the Tailored Plans will continue to receive care as they do today. 

Tailored Care Management

Need help?

Providers should contact the Tailored Plan for specific concerns and issues:

Providers may also contact the Medicaid Provider Ombudsman at 1-866-304-7062 or Medicaid.ProviderOmbudsman@dhhs.nc.gov.

Visit the NC Medicaid Help Center, an online source of information about NC Medicaid Managed Care and Medicaid.

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This page was last modified on 07/24/2025