Carolina Complete Health — the physician-led Centene joint venture — administers RB-BHT with the cleanest policy posture of the Standard Plans: its behavioral-health page states outright that clinical requirements are detailed in Policy 8F on the state's Medicaid website. The plan's own contribution is operational: an ABA Outpatient Treatment Request Checklist that structures submissions. As of April 1, 2026, WellCare of North Carolina merged into Carolina Complete Health, extending the plan from its prior regional footprint to statewide availability — see the WellCare of North Carolina guide for the merger detail and the transition path for existing WellCare members.
Clinically, everything is CCP 8F: PA before rendering any RB-BHT service (assessment included), authorization cycles tiered by intensity (180 calendar days at ≤16 hrs/week, 90 days above), treatment-plan reviews at each goal's target date and on any change in needs, provider or services. Requests go through the provider portal accompanied by the plan's ABA Outpatient Treatment Request Checklist — using it as your internal submission template removes back-and-forth. Behavioral health is integrated in-house (clinical training questions go to BH_training@centene.com), and provider services runs at (833) 552-3876, Monday–Saturday 7am–6pm. Carolina Complete Health became a statewide Standard Plan effective April 1, 2026, when WellCare of North Carolina merged into it — so eligibility should no longer be screened by county for this plan. Note also that Partners Health Management's Tailored Plan documentation cross-references CCH policies, reflecting shared Centene infrastructure.[5][6][7][3]
Code set: like every NC Medicaid plan, this one pays RB-BHT only under the CPT codes in CCP 8F Attachment A, 97151–97157, in 15-minute units. 97158, 0362T and 0373T are not covered, and no HCPCS H-code (H0031, H0032, H2014, H2019) is an RB-BHT code. The plan publishes no different code list. 96112 (developmental testing) is likewise not an RB-BHT code; NC Medicaid’s billing guidance lists it among procedure codes shared by physical and behavioral health.[5][6][7][3]
Closed by statute for RB-BHT. Session Law 2026-41 §9E.22 (approved July 7, 2026) amended G.S. 108D-22 so that "each PHP shall develop and maintain a closed network, and may exclude providers from that closed network" for peer support services and research-based behavioral health treatment services. That binds Carolina Complete Health as an NC Medicaid Standard Plan. Being enrolled in NCTracks therefore no longer guarantees a contract.[8][15]
As of October 1, 2026 no Carolina Complete Health notice on how it is applying the closed network was found. The Tailored Plans that have published one (Trillium, Vaya, Partners, Alliance) keep current contracted providers and review new applicants against network need. Ask Carolina Complete Health provider contracting whether it is accepting new RB-BHT providers in your counties before you plan on it.[8][15]
North Carolina licenses the practice itself: “it shall be a violation of this Article for any individual not licensed under this Article to practice behavior analysis” (G.S. 90-746(a); a Class 2 misdemeanor under 90-746(b)), with exemptions for NC-licensed psychologists and for behavior technicians working under a licensed professional’s direction (G.S. 90-745). An analyst licensed elsewhere has two routes: a temporary license for one who “resides and practices behavior analysis in another state,” available “only if the behavior analysis services are to be delivered during a limited and defined period of service approved by the Board” (G.S. 90-740), and licensure by reciprocity for someone actively licensed in a state with comparable requirements that reciprocates with North Carolina (G.S. 90-741). Article 43 contains no telehealth exception, so plan on an NC license before treating a child located in North Carolina by video.[9][10][11][12]
For NC Medicaid the answer is now no for a new enrollee. Session Law 2026-1 added G.S. 108C-9(e): “Board Certified Behavior Analysts and Qualified Autism Services Practitioner Supervisors shall not be permitted to enroll in the North Carolina Medicaid program as out-of-state providers,” applying to enrollment applications submitted on or after the law took effect. NC Medicaid’s August 31, 2026 reminder restates it: all LQASPs and C-QPs, “including Board Certified Behavior Analysts and Board Certified Assistant Behavior Analysts, seeking to enroll in the NC Medicaid program must do so as an in-state provider,” effective August 2, 2026.[9][10][11][12]
Federal rules make the state Medicaid enrollment rule binding on the plan: the state “must screen and enroll, and periodically revalidate, all network providers” of Medicaid managed care plans (42 CFR 438.602(b)(1)). So a BCBA in Carolina Complete Health’s network has to be enrolled with NC Medicaid as well.[9][10][11][12]
NC Medicaid’s rule binds the plans: CCP 8F (amended 8/1/2026) requires prior approval before RB-BHT services, says services provided without prior authorization “are not considered for payment or reimbursement except in the case of retroactive Medicaid eligibility,” and lists “services provided without prior authorization by the PHP” among the services Medicaid does not cover.[6][16]
Carolina Complete Health’s 2026 manual defines retrospective review as an initial review of services “for which authorization and/or timely notification to Carolina Complete Health was not obtained due to extenuating circumstances”; its examples include a member unable to give eligibility information and “Late eligibility notification from DHHS.” Requests go in “up to 90 days after the date of service (DOS),” with clinical documentation and “Specific details as to why an authorization was not obtained,” and the plan has 30 calendar days to decide. After 90 days the request “will not be reviewed and will deny for lack of timely notification,” and a timely request without clearly defined extenuating circumstances is denied administratively.[6][16]
NC Medicaid sets these for every Standard Plan, Carolina Complete Health included. Its prompt-payment fact sheet gives Standard Plans a 365-day timely filing window (in effect since July 1, 2023), covering the original claim and any corrected claim. A late claim is not invalidated if filing on time was not reasonably possible, as long as it is filed as soon as possible and within a year of the original deadline.[13][2][3][1]
Within 18 calendar days of receiving a medical claim the plan must say whether it is clean or pend it and ask for what is missing. It must pay or deny a clean claim within 30 days, and deny a claim when requested information has not arrived within 90 days. Late payment carries 18% annual interest, without the provider having to ask. Check your own contract too, since a provider agreement can set its own terms.[13][2][3][1]
Carolina Complete Health’s billing manual (updated July 14, 2026) gives the same deadlines in its own words. Contracted providers submit first-time claims within 365 calendar days of the date of service; non-contracted providers have 180. Corrected claims have the same windows, measured from the date of service: 365 calendar days for contracted providers and 180 for non-contracted. For a secondary claim behind commercial insurance or Medicare, CCH allows “three hundred and sixty-five (365) Calendar Days from the primary insurer’s Explanation of Benefits/Remittance Advice date (whether the claim was paid or denied).” Send it electronically with the EOB/RA attached. The manual publishes no payment-cycle day or submission cutoff.[13][2][3][1]
EVV does not apply to RB-BHT: NC Medicaid’s billing guidance lists the services “subject to EVV for Managed Care” as Personal Care, Home Health, Innovations Waiver, TBI and 1915(i) services (§3.52).[13][2][3][1]
Taxonomy: the plan must “validate the taxonomy code submitted on the claim” against the provider’s NC Medicaid enrollment record and “price claims based on the taxonomy code submitted on the claim” (billing guidance §3.22), so bill the taxonomy you are enrolled under in NCTracks. CCH’s billing manual puts the billing taxonomy in 837P loop 2000A (box 33b with qualifier ZZ on paper) and the rendering taxonomy in loop 2310B (box 24Ja). If a referring provider is shown in box 17, box 17a carries ZZ plus that provider’s taxonomy.[13][2][3][1]
Referring or ordering NPI: not required on an RB-BHT claim. NC Medicaid’s OPR guidance lists the claim types that need an ordering NPI (home infusion, private duty nursing, labs, IDTF, CAP, radiology, DME, LEA) or a referring NPI (home infusion, specialized therapy, hospice, home health, PDN, dialysis, CAP, LEA), and RB-BHT is not on either list. The physician or psychologist who signs the service order must still be enrolled in NC Medicaid (42 CFR 455.410).[13][2][3][1]
Disputes and appeals: for dates of service from 4/1/2026, a Provider Claim Dispute (wrong amount, eligibility, other-insurance or payment-policy denials) is due “within ninety (90) calendar days from the date of the EOP/ERA (par providers) and sixty (60) days … for non-par providers.” File it through the secure portal, or by mail or fax (833-641-0206) using the Claim Appeal/Disputes Form, one claim per form. A Provider Claim Appeal of an adverse authorization decision is due within 60 days of the original authorization notice, after which the decision is final.[13][2][3][1]
The questions that decide whether a family can start with Carolina Complete Health, and what they have to bring. Each maps onto something intake should ask on the first call.
Follows the NC Medicaid rule: CCP 8F carries no upper age bound (the 8/1/2026 rewrite removed "under 21 years of age" from the eligibility provision), under-21 members carry the EPSDT special provision, and beneficiaries under three may start on a provisional diagnosis.[6]
Follows the NC Medicaid rule: no expiry on the ASD diagnosis itself, but a provisional under-3 diagnosis must become non-provisional within six months, an adaptive behavior assessment must be under 3 years old, and diagnostic documentation must be verified and on file before services start.[6]
Follows the NC Medicaid rule: a non-provisional ASD diagnosis comes from a Licensed Psychologist, a supervised Licensed Psychological Associate, or a physician (MD or DO); a Licensed School Psychologist evaluation may be used where the required testing is included; a provisional under-3 diagnosis may also come from a trained master’s-level licensed clinician within scope.[6]
Follows the NC Medicaid rule: the ASD diagnosis must use BOSA, Tele-ASD-Peds, ADOS-2, or CARS2-ST/CARS2-HF; screeners, educational determinations and informal impressions cannot start services. The packet also needs a skills assessment (VB-MAPP, ABLLS-R or ESDM Curriculum Checklist), an FBA where challenging behaviors are targeted, and an adaptive behavior assessment within 3 years (VABS-3, ABAS-3 or DP-4).[6]
Follows the NC Medicaid rule — an MD/DO/Licensed Psychologist service order, dated on or before the first service, assessment-based, valid one year. Carolina Complete Health states outright that the clinical requirements are detailed in Policy 8F on the state Medicaid website; its own layer is the ABA Outpatient Treatment Request Checklist that structures portal submissions.[6][5]
Follows the NC Medicaid rule (Attachment A, eff. 8/1/2026): GT telehealth is billable for 97151 with clinical justification and for 97155 up to 50% of total 97155 billing per beneficiary per 180 days; telehealth is removed entirely for 97152, 97153 and 97154; 97156 and 97157 remain telehealth eligible and are the only KX telephonic services, on a documented caregiver health or access barrier. NC Medicaid’s billing guidance binds the plan to the same edit: “Claims submitted with Modifier GT (Telehealth) for 97152 - 97154 are not reimbursable and should be denied” (v36 §3.54.1). Telehealth claims carry the provider’s usual place-of-service code (8F Attachment A), and 8F does not require the telehealth modality to be named on the authorization.[6][3]
CCH’s 2026 manual (merged with WellCare NC on April 1, 2026) says standard decisions "will be made within fourteen (14) calendar days" and urgent/expedited ones "within seventy-two (72) hours of the receipt of the request"; concurrent reviews are decided within 72 hours of receiving the necessary information. It states the change as "Effective January 1, 2027": standard requests "within 7 calendar days, with a possible extension up to 14 calendar days." That date conflicts with the federal rule, which caps standard decisions at 7 calendar days for rating periods starting on or after January 1, 2026, and NC’s rating period starts July 1, so the ceiling reaches NC plans from July 1, 2026 — confirm with CCH UM which clock it is running. Lead time: the manual asks for standard requests "at least fourteen (14) business days prior" to the service (another passage says 14 calendar days); CCP 8F requires the RB-BHT reauth before the current authorization expires.[16][17][18][6]
CCH is payer of last resort: bill the other insurer first and upload its EOB/EOP or rejection letter — without it "the claim will pend and/or deny until this information is received." Secondary claims are due within 365 calendar days of "the primary insurer's Explanation of Benefits/Remittance Advice date (whether the claim was paid or denied)." Check other coverage in CCH’s portal. Neither the provider nor the billing manual lists pay-and-chase services; the state’s plan billing guidance requires plans to pay and chase EPSDT and claims under a PA "approved as EPSDT medical necessity." The manual does not say whether its own prior authorization is still needed when it pays second; CCP 8F requires prior approval before rendering RB-BHT and carves out no exception for members with other insurance, so get the plan’s authorization on file unless the plan confirms in writing that it is waived. Under federal rules TRICARE pays before Medicaid and CHAMPVA pays first when the child is also Medicaid-eligible.[16][2][3][6][19][20]
Coverage decides whether Carolina Complete Health pays. These decide whether the claim survives: how sessions must be staffed and supervised, what may be billed concurrently, the per-day ceilings, who signs the note, where the service is payable, and whose NPI the claim goes out under.
Follows the NC Medicaid rule: at least 10% of paraprofessional-delivered services must involve LQASP observation and direction, and above 200 paraprofessional hours per 180 days the LQASP-to-paraprofessional ratio must sit between 10% and 20%, documented in the treatment plan with deviations clinically justified. Incidental supervision is not billable. Neither CCP 8F nor the plan’s own manual caps how many paraprofessionals one LQASP may supervise; the limits are the per-beneficiary 10% floor and 10–20% band.[6]
Follows the NC Medicaid rule: 97153 or 97154 may be billed concurrently with 97155 when a paraprofessional delivers the direct service under an eligible provider’s observation, but a single rendering provider may not bill 97153/97154 and 97155 simultaneously. 97151, 97152, 97156 and 97157 allow no concurrent billing, and non-RB-BHT services may not be billed for the same clock time. Follows the NC Medicaid rule here too. ABA alongside speech, occupational or physical therapy: Policy 8F (amended 8/1/2026) §4.2.1(n) does not cover "non-RB-BHT Medicaid services billed at the same time as RB-BHT service (as reflected in the session note …). Same-day delivery is allowable." So a speech, OT or PT visit may fall on the same day as ABA, but not on the same clock time as a billed RB-BHT session — and the session note, which must record session time in and out (§5.5.1), is what shows the two did not overlap. §4.1(c) separately excludes any service that duplicates another provider's service.[6]
Two different ceilings. Per day, a claim edit: NC Medicaid applies the CMS Medicaid National Correct Coding Initiative to professional claims, including Medically Unlikely Edits — units-of-service edits that define for each CPT or HCPCS code "the number of units of service that is unlikely to be correct" — and its billing guidance tells every health plan to apply NCCI and MUE edits as well (§3.6.2). Carolina Complete Health’s billing manual edits claims against the CMS NCCI tables, MUEs included: "MUE’s reflect the maximum number of units that a provider would bill for a single enrollee, on a single date of service." The public CMS Medicaid NCCI practitioner MUE table for dates of service 10/1–12/31/2026 sets these maxima per beneficiary per date of service: 97151 32 units, 97152 16, 97153 32 (8 hours), 97154 18, 97155 24, 97156 16, 97157 16, 97158 16, 0362T 16 and 0373T 32. Units above the MUE on one date of service deny as a claim edit whatever the authorization allows; the authorization, not the MUE, is the real weekly limit. Per authorization period, the NC Medicaid rule (CCP 8F sets no per-day cap of its own): plans at or under 16 hours a week run 180-day initial and reauthorization cycles; plans above 16 hours a week run 90-day cycles. Within a 180-day period, 97155 telehealth is capped at 50% of 97155 billing and at least six caregiver training sessions are required. Educational-setting and IEP hours are excluded from the treatment-hour calculation.[6][3][4][2]
Follows the NC Medicaid rule: the staff member who delivered the service signs the note with credentials (professional) or job title (paraprofessional), and an LQASP or C-QP is not required to countersign a note written by non-LQASP/C-QP staff. A full note is required per contact per date of service with the elements listed in 8F subsection 5.5.1, and the treatment plan is signed and dated by the LQASP and the consenting party before services begin.[6]
Follows the NC Medicaid rule: clinic, home, school and community settings are all payable in any combination, individually justified and documented in the treatment plan, with the goal of advancing toward natural settings. IDEA-duplicative school services are excluded, and telehealth or telephonic claims carry the provider’s usual place-of-service code.[6]
Follows the NC Medicaid rule: a professional CMS-1500/837P claim through the plan, with Attachment B fixing which provider type may render each code; behavior technicians must hold RBT or ABAT certification within 120 calendar days of hire or of the agency’s first Medicaid enrollment, and all LQASPs and C-QPs must enroll as in-state NC providers as of August 2, 2026.[6]
Yes — RB-BHT per NC Clinical Coverage Policy 8F, which the plan defers to explicitly. PA is required before any RB-BHT service, submitted through the provider portal with the plan's ABA treatment-request checklist.
Yes, as of April 1, 2026 — it absorbed WellCare of North Carolina and now operates statewide as a Standard Plan, rather than the smaller regional footprint it held before the merger.
For RB-BHT, NC law has required a closed network since July 7, 2026 (S.L. 2026-41 §9E.22), so Carolina Complete Health may decline new providers. It had published no notice on how it is applying this as of October 1, 2026; ask its provider contracting team directly.
Carolina Complete Health applies CCP 8F, which does not say an authorization transfers. CCP 8F treats needing "a different RB-BHT provider agency" as a transition or discharge reason, requires the Treatment Plan to be reviewed on a change in service provider, bases prior approval on the Treatment Plan submitted with the request, and will not pay two providers for duplicate services. Expect the new agency to submit its own request, and confirm with Carolina Complete Health utilization management.
North Carolina requires an NC license to practice behavior analysis (G.S. 90-746), with no telehealth exception; temporary and reciprocity licenses exist (G.S. 90-740, 90-741). NC Medicaid no longer enrolls BCBAs as out-of-state providers (G.S. 108C-9(e)), and plan network providers must be enrolled with the state (42 CFR 438.602(b)(1)).
Only for extenuating circumstances (late DHHS eligibility notification is one), requested within 90 days of the date of service with the reason the authorization was not obtained; decision within 30 calendar days.
365 days from the date of service, the window NC Medicaid requires of every Standard Plan since July 1, 2023, corrected claims included. Clean claims must be paid or denied within 30 days. Check your Carolina Complete Health contract for any agreed terms.
Payer policies change frequently and vary by plan, state, and funding type. This guide was compiled from the sources above and last reviewed October 2026; it is general information, not billing, legal, or clinical advice. Always verify current requirements against the payer's live policy and a benefits check for the specific member.
Carelu collects all of this automatically.
Every ID, document, and detail this payer requires — gathered conversationally the moment a family reaches out, with insurance verified before your team touches the file.
Get a Demo