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WellCare will be performing maintenance on Saturday, December 21, from 6 P.M. EDT to 8 A.M. EDT the next day. You might not be able to access systems or fax during this time. We are sorry for any issues this may cause. Thank you for your patience. If you need assistance, contact us.

What are Tailored Plans?

A tailored plan is an integrated health plan for individuals with significant behavioral health needs or intellectual/developmental disabilities. Tailored plans are required to contract with a licensed prepaid health plan, such as WellCare of NC. WellCare currently contracts with two Tailored Plans, Alliance and Vaya. Beneficiaries who qualify for a Tailored Plan are auto enrolled into a Tailored Plan based on their region. This model for the Tailored Plans goes live on July 1, 2024, and until that point, they are considered Local Management Entities (LMEs). Tailored Care Management went live on December 1, 2022.

Alliance Counties: Cumberland, Durham, Harnett, Johnston, Mecklenburg, Orange, and Wake

Vaya Counties: Alamance, Alexander, Alleghany, Ashe, Avery, Buncombe, Caldwell, Caswell, Chatham, Cherokee, Clay, Franklin, Graham, Granville, Haywood, Henderson, Jackson, Macon, Madison, McDowell, Mitchell, Person, Polk, Rowan, Rockingham, Stokes, Swain, Transylvania, Vance, Watauga, Wilkes, and Yancey

Members

Eligible members with complex behavioral health needs or intellectual/developmental disabilities are enrolled in one of the 2 regional tailored plans, noted above, that correspond with the member’s county of residence.

Members of these plans will get a care manager who coordinates a member’s care team.

To get in touch with their tailored plan and learn more about care management through a tailored plan, members can reach their plan at the following:

Providers

Providers are encouraged to contract with each Tailored Plan in their service area, but it is not required. However, PCPs who contract with fewer Tailored Plans risk losing beneficiaries.

A provider wishing to participate in a Tailored Plan network should contact the Tailored Plan. If a Tailored Plan leverages a Standard Plan’s provider network, the provider will be referred to the Standard Plan.

Partnerships between Tailored Plans and Standard Plans vary. Tailored Plans may leverage all or part of their Standard Plan partner’s provider network and provider contracts.

Vaya and Alliance have their own provider networks. Providers are encouraged to reach out to Tailored Plans for the most up to date information.

Providers can reach the plans at:

Alliance:

Vaya:

Alliance Health Authorizations

Announcement: As of 2/1/2024, a Tailored Plan that WellCare of NC was previously partnered with, Eastpointe, consolidated with Trillium, which became the surviving entity. WellCare of NC will no longer be in a relationship with this entity for Tailored Plan work or implementation.