Here are links to the manuals, forms, and policies available to you. Any documents and items offered in electronic format can be requested in paper format. To request a document in paper format, please contact Member Services at 1-833-552-3876 (TTY 711).

Once you have completed your request, the paper format item(s) will be mailed within 5 business days from the date of the request.

Manuals

• Member Handbook - English (PDF)
• Member Handbook - Spanish (PDF)
• Preferred Drug List

Provider Directory

• Region 3 Provider Directory (PDF) - Updated June 2023
• Region 4 Provider Directory (PDF) - Updated June 2023
• Region 5 Provider Directory (PDF) - Updated June 2023

Member Forms

• Designation of Authorized Representative Form (PDF)
• Authorization to Use and Disclose Health Information (PDF)
• Revocation of Authorization to Use and/or Disclose Health Information (PDF)
• Request for Amendment of Health Information (PDF)
• Request for Accounting of Disclosures of Health Information (PDF)
• Request for Restrictions on Use and Disclosure of Health Information (PDF)
• Request for Accessing/Inspecting/Copying Health Information (PDF)

Member Resources

• Telemedicine Informational Flyer (PDF) - English/Spanish

Pharmacy

• Medicaid Prescription Claim Reimbursement Form - English (PDF)

Policies

• Utilization Management Policy (PDF)
• Opioid Misuse Prevention Pharmacy Lock-In Policy (PDF)
• In Lieu of Services (ILOS) Policy (PDF)
• Good Faith Provider Policy (PDF)
• Pharmacy Services Clinical Coverage Policies

Pregnancy Forms

• Notification of Pregnancy (NOP) Form (PDF) - English
• Notification of Pregnancy (NOP) Form (PDF) - Spanish

Privacy Practices

• Notice of Privacy Practices – English/Spanish (PDF)

Value-Added Services

• WW Program Physician Referral Form (PDF) 
• YMCA Diabetes Prevention Program and Blood Pressure Self-Monitoring Program (BPSM) Physician Referral Form (PDF)
• Educational Tutoring Services Member Authorization Form (PDF)

Auxiliary Aids, Large Print, and Interpreter Services

If English is not your first language, we can help. Call Carolina Complete Health Member Services at 1-833-552-3876 (TTY 711).

You can request free auxiliary aids and services, including any material offered electronically and other information in large print. To request an aid or service, please call Carolina Complete Health Member Services at 1-833-552-3876 (TTY 711).

We can give you, free of charge, any electronic materials translated in your language orally or in writing, access to interpreter services, and can help answer your questions in your language. For help, please call Carolina Complete Health Member Services at 1-833-552-3876 (TTY 711).