North Carolina State Health Plan Provider Information
Information for Providers
This page provides providers information regarding the North Carolina State Health Plan.
As previously communicated, the State Health Plan (Plan) ended the Clear Pricing Project (CPP) December 31, 2025.
The Plan will be rolling out a Preferred Provider program in 2026. This effort will be focused on independent primary care. The only way to become a Preferred Provider is through the following organizations: CCPN, Aledade or the Alliance. All other in-network providers will have a different cost share for Plan members in 2026. Currently there is no program for PT/OT/Chiro.
New 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).
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.
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.com.