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NC Medicaid will delay Tailored Plan launch beyond October 2023. A new launch date has not been announced. Due to the budget delay, Medicaid Expansion will not launch on October 1, 2023. Final authority must be granted by the General Assembly.

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New Provider Setup Packet

All new providers enrolling in the Alliance Health Provider Network should complete the full Practice Setup Packet to ensure accurate setup for payment and authorization submissions.

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If you need assistance in completing or submitting this form, please contact [email protected].

All new providers enrolling in the Alliance Health Provider Network should complete the full Practice Setup Packet to ensure accurate setup for payment and authorization submissions, which includes:

  1. Practice Profile
  2. Vendor Setup Packet
  3. Trading Partner Agreement and Connectivity Form
  4. ACS Portal Access Request

For our purposes, “practice” refers to the operating entity and not individual service locations.

Accessing the Setup Packet

Currently, the form must be completed online.

Save Your Progress

You may save your progress and return to the form as required until you are ready to submit.

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Alliance Health Icon Find the save button at the bottom of any section to save your progress and continue later.

Get Support

If you need assistance in completing or submitting this form, please contact [email protected].

This page was last reviewed for accuracy on 01/12/2023

Alliance Provider Support is available to answer provider questions about authorization, billing, claims, enrollment, ACS, or other issues.

Call 855-759-9700 Monday-Saturday from 7:00am-6:00pm.