Supporting our Providers
Carolina Care Plan is committed to supplying providers with the programs, information and support needed to ensure the health and well being of our members and the communities we serve.
Important Notice:
Clarification of Outpatient Billing Requirements
Carolina Care Plan follows the requirements outlined in the HIPAA Implementation Guide for electronic 837 institutional claims transactions and the National Uniform Billing Committee (NUBC) manual for UB-04 paper claims submissions. Per these guidelines, HCPCS/CPT codes are required for outpatient claims when an appropriate HCPCS/CPT code exists for the service line. All outpatient claims with dates of service on or after October 1, 2007, must be submitted with the appropriate codes in order to be considered for payment.
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Looking for Claims?
If you are looking for claims with a date of service prior to October 1, 2007 you will need to use the legacy CCP claims system by clicking the link below. Please note you will need to use the username and password you used with our old web site. Don’t remember your username? Click here, or password? Click here
CLICK HERE TO VIEW CLAIMS WITH DATES OF SERVICE PRIOR TO OCTOBER 1, 2007
For claims with a date of service October 1, 2007, and after, you are required to access Carolina Care Plan eligibility and claim status information through Emdeon Office or other products supported by your practice management system.
If you are a registered user with Emdeon Office:
CLICK HERE TO VIEW CLAIMS WITH DATES OF SERVICE ON OR AFTER OCTOBER 1, 2007
Carolina Care Plan and Emdeon Business Services are pleased to announce that, when using Emdeon Office for Carolina Care Plan transactions only, all eligibility and claims status inquiries will be free. Providers can register for this no cost solution by clicking here . This link is exclusive to Carolina Care Plan network providers. To learn more about Emdeon Office, go to http://office.webmd.com and click on Office Tour for an overview
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Using NPI with Carolina Care Plan
The use of the HIPAA-mandated National Provider Identifier (NPI) in addition to the Tax ID number is required on all submitted claims to minimize any delays in payment and aid in the accurate processing of claims. Learn More 
SuperWell Health Management Programs
Carolina Care Plan offers SuperWell Health Management programs that provide education and support for our members who have been diagnosed with certain chronic diseases or those who are currently pregnant. See our full list of SuperWell Health Management programs today.
Contact Care Management
The Care Management Department is available to address inquiries regarding the following:
Inquiries outside of regular business hours can be left on confidential voice mail at the telephone numbers listed below and will be addressed within one business day.
- Utilization Management (inpatient admissions, denials, appeals, referrals, etc.) Monday through Friday (excluding holidays) from 8:15 a.m. to 4:15 p.m. EST at 800/258-3021.
- Behavioral Health Utilization Management provided by MHNet Behavioral Health (MHNet) a mental health and substance abuse provider (inpatient and outpatient mental health and substance abuse services) 800/877-6003.
- Case Management Department (provides cost effective options for selected members with complex medical and social needs). To contact our Case Management Department call 800/590-2583.
- Clinical Quality Improvement Department (produces clinical practice guidelines, provider tools, clinical studies, etc.). Call 800/586-4523.
- Clinical Resources (several clinical resources are available via this Web site or upon request) Documents available from this Web site are underscored in the appropriate sections. Paper copies can be requested via mail at: Carolina Care Plan, 2060 E. Ninth Street, MZ: 01-5B-7501, Cleveland, OH 44115, or by calling 800/586-4523.