North Carolina’s IDD billing environment changed fundamentally on July 1, 2024 when the state launched its Behavioral Health and Intellectual/Developmental Disabilities Tailored Plans. Two years into implementation, the operational reality of Tailored Plan billing is significantly more complex than the transition materials suggested, and providers who have not fully adapted their billing workflows are leaving revenue at risk. For those entering the North Carolina market in 2026, the system requires careful navigation from the first claim. Here is what IDD providers need to know.
What Tailored Plans Changed About North Carolina IDD Billing
Before July 1, 2024, most IDD and behavioral health services for North Carolina Medicaid enrollees were managed through Local Management Entity/Managed Care Organizations operating as prepaid inpatient health plans. Services were authorized and administered through the LME-MCO structure, but fee-for-service claims went through NCTracks, the state’s Medicaid Management Information System.
The Tailored Plan launch changed the billing destination for members enrolled in Tailored Plans. Tailored Plans are behavioral health and IDD specialty plans operated by the state’s LME-MCOs. For Tailored Plan members, claims for covered services go to the Tailored Plan, not to NCTracks. If you serve this population and are billing NCTracks for services to Tailored Plan members, the claims are going to the wrong destination and will not be paid regardless of how accurate the documentation and coding are.
This distinction, NCTracks for standard plan members and fee-for-service, Tailored Plan directly for Tailored Plan members, is the foundational billing reality that every North Carolina IDD provider must manage correctly.
The Four Tailored Plans and Their Geographies
There are four Tailored Plans in North Carolina, each assigned to specific counties. A member’s Tailored Plan is determined by their administrative county, which is the county that manages their Medicaid case, not necessarily the county where they live or receive services. The four Tailored Plans are:
Alliance Health, serving Wake, Durham, Johnston, and other Triangle-area counties. Alliance Health manages behavioral health, IDD, and TBI services for its member counties and operates its own claims submission portal and prior authorization system.
Partners Health Management, serving Forsyth, Guilford, Alamance, and surrounding counties in the Piedmont Triad and western central region of the state. Partners has its own network requirements, billing portal, and provider manual that governs claims for its Tailored Plan members.
Trillium Health Resources, which following its merger with Eastpointe Human Services in February 2024, now serves 46 counties across eastern, southeastern, and parts of central North Carolina. Trillium is the largest Tailored Plan by geographic coverage and among the most active in terms of provider-facing billing policy changes in 2026.
Vaya Health, also known as Vaya Total Care, serving the western counties of North Carolina including Asheville and the mountain region. Vaya administers Tailored Plan services for members in its geographic area with its own prior authorization and claims submission requirements.
For IDD providers serving clients across multiple North Carolina counties, the reality of operating in multiple Tailored Plans simultaneously means maintaining separate credentialing, separate contracts, and separate billing portal access for each plan that serves clients in your geographic footprint.
The October 2026 Trillium Direct Billing Transition
The most operationally significant billing change in North Carolina in 2026 is the Trillium direct billing transition taking effect October 1, 2026. Even if you currently participate in the Trillium network through Carolina Complete Health, you must transition to submitting claims directly to Trillium beginning October 1, 2026. This requirement applies to nearly all participating providers, with the only exceptions being NEMT and vision vendors. Providers are encouraged to complete onboarding steps with Trillium by September 22 in anticipation of the October 1 launch.
This transition means that providers who have been submitting Trillium Tailored Plan claims through Carolina Complete Health must establish direct billing access with Trillium’s claims system, complete any required re-credentialing or contracting steps, and update their billing workflows to route Trillium member claims directly to Trillium rather than through the Carolina Complete Health pathway. Claims submitted through the old pathway after October 1 will not be processed. Providers who miss this transition will experience immediate claims disruption.
Trillium has also been managing rate alignment across its expanded territory following the Eastpointe merger. Trillium has added double asterisks next to services that have unified rates across all legacy LME-MCOs, reflecting the organization’s ongoing efforts to work toward rate alignment across the newly merged organization. Providers should review current Trillium rate schedules to ensure their billing configurations reflect the current unified rates rather than the pre-merger Eastpointe or Trillium rates that may have differed.
EVV in North Carolina’s Tailored Plan Environment
North Carolina completed EVV implementation for the Tailored Plan population in 2025. For IDD providers delivering home and community-based services to Tailored Plan members, EVV is required and must be submitted through the appropriate aggregator connected to the member’s Tailored Plan.
For Tailored Plan billing, each LME-MCO operates its own claims portal and EVV process. This means EVV requirements, submission processes, and validation rules may differ between Alliance Health, Partners, Trillium, and Vaya. Providers serving members across multiple Tailored Plans must understand the EVV requirements specific to each plan and ensure their EVV system is configured to meet each plan’s validation requirements.
Vertex EVV Manager completed EVV implementation for North Carolina providers in 2025 as part of Vertex’s state-specific expansion. For North Carolina IDD providers using Vertex, the EVV system is configured for North Carolina’s requirements and supports the submission pathways needed for Tailored Plan compliance.
NCTracks: Still Relevant for Some Billing
Not all North Carolina Medicaid billing has moved to Tailored Plans. Members who are not enrolled in a Tailored Plan, members receiving services not covered under the Tailored Plan benefit, and certain fee-for-service situations still bill through NCTracks. For IDD providers, understanding which of their clients are Tailored Plan members and which are not is the foundational step for routing claims correctly.
The practical workflow for North Carolina IDD providers is to verify each client’s Tailored Plan enrollment status at intake and at any point when their enrollment status may have changed, and to route claims to the correct destination accordingly. An IDD provider serving 80 clients may have 60 enrolled in Tailored Plans across multiple LME-MCOs and 20 still on standard Medicaid billing through NCTracks. Each group requires a different billing workflow and a different claims submission destination.
Provider Credentialing Across Multiple Tailored Plans
For IDD providers seeking to serve members across all four Tailored Plan geographies, credentialing and contracting with each LME-MCO is required. The credentialing requirements and contracting processes differ between plans and take time to complete. Providers expanding into new North Carolina counties should factor Tailored Plan credentialing lead time into their expansion planning, as serving members in a new LME-MCO geography without an active contract will result in claims that cannot be paid.
Trillium’s Unified Claims System for Tailored Plan operations reflects the organization’s ongoing effort to streamline provider-facing billing as the merged Trillium territory stabilizes. Providers should monitor Trillium provider communications for updates on system changes that affect claims submission processes.
What North Carolina IDD Providers Need From Their Billing System
Multi-LME-MCO billing management: A billing platform must handle separate payer configurations for each Tailored Plan in a provider’s network, routing claims to the correct destination based on each member’s enrollment, applying the correct rate schedule and authorization structure for each plan.
NCTracks for non-Tailored Plan members: The billing system must also handle NCTracks fee-for-service billing for members not enrolled in Tailored Plans, without requiring a separate system or manual routing by billing staff.
EVV integration with North Carolina aggregators: Visit verification data must flow correctly into Tailored Plan billing workflows with the North Carolina-specific configuration that each plan requires.
Real-time authorization tracking: Authorization management across multiple Tailored Plans with different authorization systems and unit structures requires billing software that tracks authorizations at the client level regardless of which plan is managing them.
Vertex Systems supports North Carolina Tailored Plan billing with state-specific configurations for the LME-MCO environment and EVV implementation completed for North Carolina providers in 2025. Connect with the Vertex team to discuss North Carolina-specific billing support and what the Trillium direct billing transition means for your agency’s October 2026 deadline.
