Open Enrollment begins this year

Aetna® will be the new third-party administrator for the North Carolina State Health Plan beginning January 1, 2025. Open enrollment begins in the fall of 2024, which is when members will select a primary care provider (PCP).

Here are the steps you can take to get ready:

Step 1: Join the Aetna Network

The North Carolina State Health Plan will use Aetna’s Choice POS II network. If you are not already participating with Aetna, join our network as soon as possible.

Step 2: Join the Clear Pricing Project (CPP)

Join the CPP by May 31, 2024. If you’re a current CPP provider, you will need to re-enroll in the CPP with Aetna. Visit North Carolina State Health Plan for more information.

Step 3: Make sure your provider profile information is accurate and up to date

Our provider search tools play a key role in connecting members with providers. Ensure that your information is correct and available to our members when they need care.

You can follow along with our quick reference guide (PDF) to make essential updates in the Provider Data Management (PDM) tool on our Availity provider portal.*

If your practice is new to Availity, you can register to set up your account. If you’re unable to use Availity, go to our Update Your Provider Data page.

Step 4: Credential mid-level primary care providers

If you’d like members to be able to select nurse practitioners and physician assistants as their PCPs, you need to credential them with Aetna. You can do this by visiting our Join Our Network page. In the “I am joining” drop-down menu, select “a provider applying under a SSN or TaxID/EIN that is currently participating with Aetna.”

Questions?

Send an email message to the Aetna Network Management staff or call us at 1-800-353  1232 (TTY: 711) during normal business hours.

To stay informed and keep in better touch with us, sign up for email communications.

*Availity is available only to providers in the U.S. and its territories.