NC Medicaid Standard, Tailored and Direct Credentialing
By George Ruan • October 9, 2026
Last updated: October 9, 2026.
Start with NC Medicaid's official health-plan list and NCDHHS LME/MCO directory. As of October 9, 2026, there are four Standard Plans and three Tailored Plans. Your NCTracks enrollment establishes the state provider record; the network and claim route still depend on the member's program and the service.
Sections
Current NC Medicaid Standard Plans
The state's April 2, 2026 quick reference lists these four Standard Plans:
AmeriHealth Caritas North Carolina.
Carolina Complete Health.
Healthy Blue.
UnitedHealthcare Community Plan.
WellCare of North Carolina merged with Carolina Complete Health on April 1, 2026. The official merger notice states that the unified plan is Carolina Complete Health and is available statewide. Do not count WellCare as a fifth current Standard Plan or rely on older pages limiting Carolina Complete Health to three regions.
Current Tailored Plans and LME/MCOs
As of October 9, 2026, the NCDHHS county directory lists Alliance Health, Trillium Health Resources and Vaya Partners Health. NC Medicaid’s September 10, 2026 merger letter confirms that Vaya Health and Partners Health Management merged effective October 1, 2026 as Vaya Partners, including the Tailored Plan and LME/MCO. Use the updated directory to check the organization assigned to a county.
The generic Tailored Plans page still lists the legacy four organizations. Its pre-October 1, 2026 names do not override the September 10 merger notice and current directory. The page describes Tailored Plans as combining physical health with behavioral health and other supports for eligible members with more complex needs; use that program description separately from the current organization list.
Do not select a plan only from the therapist's office address. Verify the beneficiary's actual enrollment and coverage period. A plan's physical-health partner or claims administrator also does not automatically determine where every behavioral health claim belongs; follow the plan's service-specific instructions.
NC Medicaid Direct does not mean every claim goes to NCTracks
NC Medicaid's program descriptions distinguish Direct from managed care. LME/MCOs can still administer behavioral health services for Direct members. For a therapist, that means checking both the member's program and who manages the specific service, rather than treating a Direct label as an instruction to bill all therapy to NCTracks.
The state claims-routing fact sheet addresses this distinction and managed-care carve-outs. Use our eligibility walkthrough to identify the managing entity, then confirm the relevant benefit with the responsible payer.
State credential verification versus plan contracting
Begin with NCTracks enrollment for the clinician and group. NC Medicaid's provider-data guidance says PHPs accept the Department's verified credentialing information. Plans may request contracting information, while requesting additional credentialing information requires the Department's written approval. Avoid treating each plan as a completely separate repeat of the state's credential verification.
Use the provider contracting resources to approach the networks you need. Confirm the contracting entity, covered services, participating clinicians and locations, and effective dates in the plan's approval. A completed NCTracks record is not itself a contract with every Standard or Tailored Plan.
As of this review, the state credentialing page says implementation of delegated enrollment/credentialing is paused. The PDM/CVO implementation hold also keeps enrollment activities in NCTracks. Do not confuse these paused projects with the requirement to maintain the current provider record.
Check for another program before routing a claim
These three categories are not an exhaustive list of every member's arrangement. The state's program directory also includes Healthy Blue Care Together, the Children and Families Specialty Plan, and the EBCI Tribal Option. Healthy Blue Care Together is a distinct specialty plan, not a fifth Standard Plan.
Record the verified program for the date of service, then use behavioral health claims and telehealth guidance. If provider data needs correcting, use the existing location and group-affiliation MCR guide.
Frequently Asked Questions
Is WellCare still a separate NC Medicaid Standard Plan?
As of October 9, 2026, WellCare of North Carolina has merged with Carolina Complete Health. The merger took effect April 1, 2026, and the unified Carolina Complete Health plan is statewide.
What are the three current NC Medicaid Tailored Plans?
As of October 9, 2026, the current organizations are Alliance Health, Trillium Health Resources and Vaya Partners Health. Vaya Health and Partners Health Management merged October 1, 2026. Use NCDHHS’s updated directory and the dated merger notice rather than the generic page’s legacy four-plan list.
Do all NC Medicaid Direct therapy claims go to NCTracks?
No. An LME/MCO can administer behavioral health services for a Direct member. Verify the member, service and date of service before selecting the receiving payer.
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