Carolina Complete Health Network

What Carolina Complete Health Network does

Carolina Complete Health Network (CCHN) operates as the provider network and administrative platform for Carolina Complete Health, North Carolina's only Provider-Led Entity (PLE) in Medicaid managed care. Founded in 2016 as a subsidiary of the NC Medical Society and co-owned by the NC Community Health Center Association and FQHCs, the organization runs through a joint venture with Centene Corporation, which provides administrative infrastructure and operational support while physicians retain clinical governance. Following the April 1, 2026 merger with WellCare of North Carolina (also a Centene subsidiary), the combined entity serves 980,000+ members across Medicaid, Medicare, Marketplace, and Behavioral Health/I/DD Tailored Plans, with approximately 240,000 members with complex mental health, substance use, and intellectual/developmental disability needs served through four specialized Tailored Plans.

The organization earns revenue through capitation payments from NC Medicaid on a per-member-per-month basis, with provider reimbursement following the North Carolina Medicaid fee schedule as a baseline. Its product portfolio includes the CCH Medicaid Health Plan, Tailored Plans, the CCH Secure Provider Portal, Prior Authorization Lookup Tool, Behavioral Health Services, Home Health and Personal Care Services with Electronic Visit Verification via HHAeXchange, the Advanced Medical Homes (AMH) care model, Quality and Risk Adjustment Programs, Healthy Opportunities Program addressing social determinants of health, and a Provider-Led Innovation Program funding clinical pilots. Technology infrastructure is composed of third-party integrations rather than proprietary platforms, including Availity Essentials for portal access, Payspan for EFT/ERA, HHAeXchange for EVV, NC*Notify for cross-continuum event notifications, NC HealthConnex as the state HIE, NCCARE360 for community resource referrals, and NCTracks for provider enrollment. No proprietary AI/ML platform is described.

The go-to-market model is sales-led, targeting North Carolina healthcare providers (physicians, hospitals, FQHCs, specialists) for network contracting, supported by a Provider Engagement team covering 6 statewide regions. Marketing channels include the provider network website, bi-weekly provider bulletins, training webinars, and provider workgroups. Strategic partnerships include core relationships with Centene Corporation (JV partner), NC Medical Society (founding owner), NC Community Health Center Association, and WellCare of North Carolina (merged), plus operational partnerships with Tailored Plan operators Partners Health Management and Trillium Health Resources.

Name

Carolina Complete Health Network

Legal name

Carolina Complete Health Network, Inc.

Website

https://network.carolinacompletehealth.com

Company type

Private

Founded year

2016

Operating status

Operating

Headcount range

51–100 employees

Short description

Carolina Complete Health Network is North Carolina's only Provider-Led Entity in Medicaid managed care, serving 980,000+ Medicaid, Medicare, Marketplace, and Behavioral Health/I/DD members statewide through a physician-led governance model jointly owned by the NC Medical Society and Centene.

Ownership category

akta.pro rank

Product category

Medicaid Managed Care Services

NAICS

Direct Health and Medical Insurance Carriers (524114), Direct Life, Health, and Medical Insurance Carriers (52411)

SIC

Hospital & Medical Service Plans (6324), Services-Misc Health & Allied Services, Nec (8090)

akta.pro primary industry

Provider Network & Care Management for Commercial Members (HLAEAAAL)

akta.pro secondary industries

Provider Network, Credentialing & Contracting Support (BPAAAFAI), Medicare Provider Networks & Delegated Medical Groups (MA-focused) (FSAIAGAK)

Keywords

• Medicaid managed care
• Provider network services
• Health plan administration
• Behavioral health coverage
• Value-based care coordination

Headquarters

HQ city

Raleigh

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2B

Offering type

Services

Cost components

Personnel, Operations, Technology or R&D, Marketing or Sales, Infrastructure

Revenue model

1. Medicaid Managed Care Premiums: The organization generates revenue through capitation payments from North Carolina Medicaid as a managed care organization. Premiums are received per member per month for covering Medicaid beneficiaries across Standard Plans, Medicare, Marketplace, and Behavioral Health/I/DD Tailored Plans.

Go-to-market motion1 record

Distribution channels1 record

Marketing channels5 records

Core offering

Carolina Complete Health Network operates as the provider network and administrative platform for Carolina Complete Health, North Carolina's only Provider-Led Entity in Medicaid Managed Care. Through a joint venture with Centene Corporation, the NC Medical Society, the NC Community Health Center Association, and FQHCs, the organization administers a Medicaid, Medicare, Marketplace, and Behavioral Health/I/DD Tailored Plan health plan serving over 980,000 members across North Carolina. Its core function is contracting with credentialed providers, processing claims and prior authorizations, coordinating care, and operating provider portals and innovation programs in support of the underlying health plan.

Product overview

Carolina Complete Health Network operates as a provider network and administrative platform supporting North Carolina's only Provider-Led Entity (PLE) in Medicaid Managed Care. The company offers a unified Medicaid health plan serving over 980,000 members, combined from the merger of Carolina Complete Health and WellCare of North Carolina effective April 1, 2026. The portfolio includes the core Medicaid health plan, Tailored Plans for complex needs (mental health, substance use, I/DD), provider portals for claims and authorization management, behavioral health services, home health and personal care services, Healthy Opportunities programs addressing social determinants of health, quality improvement and risk adjustment programs, and provider engagement services. The ecosystem integrates with third-party systems including Availity Essentials, Payspan, HHAeXchange, NC*Notify/NC HealthConnex, NCCARE360, NCTracks, and utilization management vendors (Evolent, EviCore).

Differentiator

Problem solved

Functional benefit

Products and services

• Carolina Complete Health Medicaid Health Plan North Carolina's only Provider-Led Entity Medicaid managed care health plan, serving over 980,000 members across Medicaid, Medicare, Marketplace, and Behavioral Health/I/DD Tailored Plans. Owned jointly by Centene, the NC Medical Society, the NC Community Health Center Association, and FQHCs.
• Behavioral Health and I/DD Tailored Plans Specialized managed care plans for North Carolinians with complex mental health needs, severe substance use needs, and intellectual/developmental disabilities, supporting approximately 240,000 individuals across four Tailored Plans.
• CCH Secure Provider Portal Unified provider portal for checking eligibility, submitting and correcting claims, checking claim status, viewing payment history, submitting prior authorizations, accessing health records and assessments, viewing AMH reports, care gaps, and quality and risk adjustment reports.
• Provider Engagement Services Field-based provider engagement team covering 6 regions across North Carolina, supporting Carolina Complete Health, Ambetter of NC, and Wellcare Medicare with provider education, orientation, Payspan support, HEDIS/care gap reviews, financial analysis, innovation and transformation support, and Advanced Medical Homes oversight.
• Provider-Led Innovation Program Program funding and supporting practice-level innovation pilots such as the CITE Pilot for pediatric behavioral health ED boarding and continuous glucose monitoring pilots for children/adolescents with obesity and asthma.
• Healthy Opportunities Program Program connecting members to community resources addressing social determinants of health including housing, food, transportation, and interpersonal safety, integrated with NCCARE360 for coordinated referrals.
• Value-Added Services Additional benefits beyond standard Medicaid coverage including enhanced hearing benefits for adults 21+, hearing aid coverage, and other services accessible via webform or care management.
• Behavioral Health Services Comprehensive behavioral health coverage including outpatient mental health therapy (24 unmanaged visits per fiscal year), Applied Behavioral Analysis for autism spectrum disorder, peer support services, psychological/neuropsychological testing, and NC-PAL provider-to-provider consultation for children, adolescents, young adults up to 21, and pregnant or postpartum patients.
• Home Health and Personal Care Services Personal Care Services (PCS) with Electronic Visit Verification via HHAeXchange, Home Health Care Services, and Long-Term Services and Supports with care management assessments and authorizations.

Quantifiable outcome

• Pediatric social hold occupancy dropped from 50-70% to <10% through CITE Pilot at Novant
• +2 more outcomes

Named customers3 records

Segments5 records

Ideal customer profiles2 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration9 records

Partnerships

Eleven partnerships are on record, tiered core and minor.

• WellCare of North CarolinacoreStrategic or Co-development Partner · 2 April 2026Merger completed April 1, 2026 combining Carolina Complete Health and WellCare of North Carolina into unified statewide health plan operating under Carolina Complete Health brand. Both were Centene subsidiaries.
• Novant Presbyterian Pediatric EDminorStrategic or Co-development Partner · 1 January 2025CITE Pilot partner addressing pediatric behavioral health ED boarding crisis. Pilot embedded a behavioral health clinician in the ED supported by MORES community services, achieving significant reductions in boarding times.
• SPARC MORES ProgramminorStrategic or Co-development Partner · 1 January 2025Mobile crisis team partner in CITE Pilot providing home, community, and ED response plus up to 8 weeks of stabilization services for pediatric behavioral health patients.
• McCormack Baron SalazarminorStrategic or Co-development Partner · 1 January 2024Development partner for affordable housing initiative in Northeast Winston-Salem. Partnership aims to rebuild 244 aging housing units into mixed-income housing and connect residents to healthcare and community resources.
• Neighbor Health Center Inc.minorStrategic or Co-development Partner · 1 January 2022Innovation pilot partner serving underserved populations in Raleigh area. Successfully integrated behavioral health services in office setting, reaching Level 4 on SAMHSA Collaboration/Integration scale and serving 472 individuals.
• Centene CorporationcoreStrategic or Co-development PartnerJoint venture partner with Carolina Complete Health Network to establish Carolina Complete Health (CCH), the Provider-Led Entity. Centene provides administrative infrastructure, technology platforms, and operational support while the provider network maintains clinical governance.
• NC Medical SocietycoreStrategic or Co-development PartnerFounding partner and partial owner of Carolina Complete Health Network. Represents physicians and physician assistants in North Carolina, providing clinical leadership and governance through the Provider-Led Entity structure.
• NC Community Health Center AssociationcoreStrategic or Co-development PartnerPartner representing federally-qualified health centers and aspiring health centers across North Carolina. Partial owner of the Provider-Led Entity, ensuring community health center representation in governance.
• Partners Health ManagementminorChannel Partner/ Reseller/ DistributorTailored Plan partner for physical health services. Carolina Complete Health processes physical health claims for Partners Tailored Plan members. Partners operates ProviderCONNECT Portal for their contracted providers.
• Trillium Health ResourcesminorChannel Partner/ Reseller/ DistributorTailored Plan partner for physical health services. Carolina Complete Health processes physical health claims for Trillium Tailored Plan members. Trillium operates Physical Health Portal for contracted providers.
• Salisbury PediatricsminorStrategic or Co-development PartnerInnovation pilot partner for continuous glucose monitoring program targeting children/adolescents with obesity and asthma to improve metabolic health outcomes.

Scale indicators3 records

Recent moves7 records

Expansion highlights5 records

Direct peers

• Healthy Blue (Blue Cross and Blue Shield of North Carolina): Healthy Blue is one of the five contracted NC Medicaid Managed Care plans and a direct competitor serving Medicaid beneficiaries across the state, including Standard Plans and Tailored Plans. Competes head-to-head with CCHN for members, providers, and value-based contracting arrangements.
• UnitedHealthcare Community Plan of North Carolina: UnitedHealthcare's NC Medicaid managed care plan is a direct competitor under the same NC Medicaid Managed Care contract structure, serving Standard Plans and competing for the same member population and provider network. Backed by UnitedHealth Group's national scale.
• AmeriHealth Caritas North Carolina: AmeriHealth Caritas operates as another contracted NC Medicaid Managed Care plan, directly competing with CCHN for Medicaid members and provider contracting. As a national Medicaid-focused carrier, it offers comparable services across physical and behavioral health.
• WellCare of North Carolina: WellCare of NC was a direct competitor that merged with Carolina Complete Health on April 1, 2026. Previously a parallel Centene subsidiary offering Medicaid and Medicare Advantage plans in NC under the same parent. The merger consolidates two previously competing entities.
• Partners Health Management: Partners Health Management is one of four NC Tailored Plans covering behavioral health and I/DD services. CCHN processes physical health claims for Partners Tailored Plan members, creating a B2B partnership-competition hybrid relationship within the NC Medicaid ecosystem.
• Trillium Health Resources: Trillium Health Resources is another NC Tailored Plan partner where CCHN processes physical health claims for Trillium Tailored Plan members. Operates in the same specialized Medicaid managed care space serving complex behavioral health and I/DD populations.

Broad incumbents

• Centene Corporation: Centene Corporation (NYSE: CNC) is the parent company of CCHN and the largest Medicaid managed care operator in the United States. Other Centene Medicaid subsidiaries (Sunshine Health, Buckeye Health Plan, etc.) serve as sister entities with comparable operating models in other states.
• Molina Healthcare: Molina Healthcare is a national Medicaid-focused managed care company with comparable state-contract-based operating model, government-program concentration, and value-based contracting strategies. Operates Medicaid plans in many of the same states as Centene subsidiaries.
• Sunshine Health (Centene Florida): Sunshine Health is a Centene Medicaid subsidiary in Florida offering comparable Medicaid managed care services under the same parent operating model. Serves as a sister subsidiary reference for CCHN's operating playbook and technology infrastructure.
• Elevance Health (Anthem Medicaid): Elevance Health (parent of Anthem Blue Cross Blue Shield plans) operates Medicaid managed care plans in multiple states and competes with CCHN's parent Centene nationally. HealthSun Health Plans and Anthem state Medicaid subsidiaries serve comparable low-income populations.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat4 records

Key risks6 records

Key highlights6 records

Customer concentration

• LinkedInlinkedin.com/company/carolinacompletehealthnetworkinc.

Revenue estimate

Valuation estimate

Number of profiles

Profiles1 record

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments1 record

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Carolina Complete Health Network