N.C. State Health Plan Network
State Health Plan Network Information for Providers
This page includes provider information regarding the NC State Health Plan Network.
The State Health Plan (Plan) would like to extend its sincere gratitude to the organizations that have supported the Plan and its members. The Plan is facing a $507 million deficit which we are actively trying to close. This means evaluating all programs, like the Clear Pricing Project (CPP), to determine the best way to stabilize the Plan’s financials.
When CPP launched in 2020, the intention was to promote transparent health care pricing, while trying to promote quality primary care and behavioral health. CPP introduced provider reimbursement rates based on a percentage of Medicare with incenting members to visit participating providers by reducing their copay down to zero. Given that most of the providers that signed up for CPP received an increase in reimbursement rates coupled with members having no cost-share, this model has not proven to be financially viable for the Plan.
Given the current financial situation of the Plan, we must find other solutions that benefits all three parties: the Plan, members and providers. As such, the Plan will be ending CPP as of December 31, 2025. The Plan is committed to continuing its effort in promoting affordable access to behavioral health services through reimbursement rates and member cost-share; however, it will not be at the current CPP reimbursement rate and will not have a $0 member cost share.
New Behavioral Health Access Program (BHAP)
The BHAP program will offer a custom fee schedule. The fee schedule will apply to Behavioral Health provider types and specialties and a defined list of CPT codes. The fee schedule will be set at 140% of current year NC Medicare (updated annually effective May 1st) for a limited set of CPT codes (psychotherapy, evaluation and management and psychological testing). It will also include ABA and TMS codes at Aetna Market Fee Schedule (AMFS) rates (same as current CPP).
If you are a behavioral health provider and would like to sign up for this program, visit Go.Aetna.com/joinbhap
Aetna Resources
The Plan transitioned to Aetna, its new third-party administrator effective Jan. 1, 2025. As such, providers will need to be participating with Aetna’s Choice POS II network in order to see State Health Plan members on an in-network basis. If you are not currently in network with Aetna, visit Go.Aetna.com/joinournetwork to start that process.
If you have questions regarding your contract with Aetna, reimbursement rates, your application, medical policies or benefits, please call Aetna's Provider line at 888-632-3862.
Certain services require prior review and certification before they can be covered. Providers can visit the links below for more information.
For additional questions for Aetna, providers can email NorthCarolinaNetwork@aetna.com. To contact the State Health Plan office email SHPProviderNetwork@nctreasurer.com.
Archived Provider Resources (Blue Cross NC)
- BlueCross NC Provider Portal
- 2023 NCSHP Network Participation Agreement
- 2022 NCSHP Network Participation Agreement
- 2021 NCSHP Network Participation Agreement
- 2020 NCSHP Network Participation Agreement
- NCSHP Network Master Reimbursement Exhibit
- Professional Pricing Policy
- SHP Pricing Policy
- 2024 SHP Professional Fee Schedule