North Carolina State Health Plan Provider Information
Information for Providers
This page provides providers information regarding the North Carolina State Health Plan.
Becoming a Preferred Provider
Primary Care Providers may be able to join with one of the following CINs to gain preferred status. Reach out directly to the CINs to learn more:
- CCPN (dlevis@communitycarenc.org)
- Aledade (amullineaux@aledade.com)
- UNCHA (Kaitlynn.harris@unchealth.unc.edu)
Multi-Specialty Providers may be able to join the following multi-specialty CIN, Collaborative Healthcare Solutions (MOdom@wilmingtonhealth.com).
If Specialty, is the practice located in Medicaid Region 3 which includes the following counties:
- Alexander
- Anson
- Cabarrus
- Catawba
- Cleveland
- Gaston
- Iredell
- Lincoln
- Mecklenburg
- Rowan
- Stanly
- Union
If yes, then please send the following information to Beth Horner at Beth.Horner@nctreasurer.gov:
- All associated Tax Ids for the practice;
- Capacity to offer additional office visits:
- In person
- Virtual
- Procedures performed by type – include major CPT codes
- Other services offered
- Where do you refer patients to for care? Include a breakdown by %.
Behavioral Health Access Program (BHAP)
In an effort to offer continued support for Behavior Health for our members and the providers that treat them, the Plan's 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 at NC Medicaid rates 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 the Aetna website.
Signing up for this program does not impact the member cost share. Below is a link to the plan comparison chart that offers a summary of member cost shares for services.
2026 Active/Non-Medicare Member Plan Comparison
2027 Active/Non-Medicare Member Plan Comparison
Aetna Resources
Aetna is the third-party administrator for the Plan Jan. 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 the Aetna website 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.gov.