Information for Tailored Care Management Providers
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.
- List of certified TCM providers (Aug. 22, 2024)
- TCM Provider Manual (June 18, 2024)
- TCM Provider Manual Addendum: HOP Guidance for AMH+s/CMAs (June 28, 2024)
- Summary of Updates (June 18, 2024)
- TCM Program Updates (June 13, 2023)
- TCM Flexibilities and Program Changes Update (June 13, 2023)
- NC Medicaid Begins Tailored Care Management (Dec 1, 2022)
- NC Medicaid 1915(i) Assessment (May 31, 2024)
- TCM Statewide Monitoring Tool (Oct. 30, 2024)
- TCM Rate Assumption Guidance (March 5, 2024)
- TCM Provider Billing Guide (Sept. 8, 2023)
- Updated Details on the Underlying Assumptions Behind Tailored Care Management Payment Rates (June 1, 2024)
- Data Specifications Guidance
- Use of Care Manager Extenders in TCM (April 19, 2022)
- TCM for Children and Youth Served by the Child Welfare System - Quick Reference Guide (July 2, 2024)
- TCM: Conflict-Free Care Management Guidance (Aug. 26, 2021)
- Trending Topics | TCM Provider Information Verification (Sept. 6, 2023)
- Technical Advisory Group (TAG)
- TCM Capacity Building Program (June 1, 2023)
- Fact Sheet: What is Tailored Care Management? (English) (April 8, 2024)
- Fact Sheet: What is Tailored Care Management? (Spanish)
- Toolkit: Tailored Care Management
- List of certified TCM providers (July 18, 2024)
Archive
- TCM Update: AMH+/CMA Certification Round One Desk Reviews Completed (Aug. 9, 2021)
- Potential Clinically Integrated Networks or Other Partners Statement of Interest (Aug. 9, 2021
- Data on Medicaid and NC Health Choice Beneficiary Eligibility for Behavioral Health I/DD Tailored Plans and TCM (May 24, 2021)
- TCM Updates (May 14, 2021)
- Community Inclusion Addendum Added to TCM Provider Manual (March 19, 2021)
- TCM Certification Deadline Extended to June 1, 2021 (Feb. 15, 2021)
- Application Period Open for TCM Certification (Dec. 14, 2020)
- TCM Updates (June 9, 2020)
- Provider Application Process for TCM – extended deadlines (Feb. 17, 2020)
- Update: Draft Provider Manual for TCM (Jan. 17, 2020)
- Draft Provider Manual for TCM (Dec. 11, 2019)
- TCM Provider Manual | Summary of Updates (July 14, 2023)
- TCM Provider Manual (Feb. 23, 2023)
- TCM Provider Manual / Summary of Updates (April 4, 2023)
- TCM Provider Manual (Aug. 25, 2022)
- TCM Provider Manual | Summary of Updates (April 19, 2022)
- TCM Provider Manual: Community Inclusion Addendum (March 19, 2021)
- TCM Provider Manual (Dec. 2, 2020)
- Verifying Provider Information (NPI+Location Code) in NCTracks (May 17, 2022)
- Desk Review Protocol for Round 3 (Dec 6., 2022)
- TCM Application (Dec. 6, 2022)
- TCM Temporary Flexibilities and Program Changes (April 26, 2023)
- Temporary Flexibilities and Program Changes prior to 4/1 (Dec. 21, 2022)
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
- Recording
- Transcript
- Presentation
- Questions and Answers (Feb. 2, 2021)
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.
- TCM Frequently Asked Questions (Nov. 30, 2022)
- Data Strategy Questions and Answers (July 13, 2021)
Need help?
Providers should contact the Tailored Plan for specific concerns and issues:
- Alliance Health, 1-800-510-9132, TTY: 711 or 1-800-735-2962
- Partners Health Management, 1-888-235-4673, TTY/English: 1-800-735-2962, TTY/Spanish: 1-888-825-6570
- Trillium Health Resources, 1-877-685-2415, TTY: 711
- Vaya Health, 1-800-962-9003, TTY: 711
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.
This page was last modified on 11/14/2024