Medicaid Providers
Overview & Resources
WellCare of North Carolina partners with providers to develop and deliver high-quality, cost-effective health care solutions. We understand that maintaining a healthy community starts with providing care to those who need it most. We are committed to improving the quality of life of our millions of members, who often include some of our nation's most vulnerable populations.
Resources
- Provider Manual (PDF) *Important Update: Changes to our Medicaid Member Rewards Program, My Health Pays®, went into effect on July 1, 2025. Learn More.
- Quick Reference Guide (PDF)
- Provider Resource Guide (PDF)
- Provider Self-Service Quick Reference Guide (PDF)
- EPSDT Provider Toolkit (PDF)
- Provider Masters Level Proposed Rates (PDF)
- NC InCK Information for Health Care Providers (PDF)
- NC InCK Family Frequently Asked Questions (PDF)
- NC InCK Provider Frequently Asked Questions (PDF)
- Member Advisory Committee (MAC) Member Flyer (PDF)
- Member Advisory Committee (MAC) - LTSS Member Flyer (PDF)
- Managed Care PHP Member PCP Change Request Form (PDF)
- Provider Referral Form: LTSS Request for PCS Assessment (PDF)
- Credentialing and Re-Credentialing Policy (PDF)
- Utilization Management Program Policy WNC.UM.01 (PDF)
Language/Cultural Humility
WellCare of North Carolina's New Clearinghouse is Availity
Please register with Availity for direct data entry and online claims submission. Visit our Electronic Claims page, or email NC Provider Relations for more information.
Notification of Withholds, Incentive Payments, and Quality Metrics for Healthy Opportunities Pilots VBP Period 3 Implementation.