AmeriHealth Caritas North Carolina

Welcome to the AmeriHealth Caritas North Carolina Health Plan page.  The documents below have been designed to help RadMD users navigates the prior authorization process for each program Evolent is responsible for. Additional process-specific training tools and modules can be found via links on the Resources tab at the top of the screen.

Reminder: Re-reviews for AmeriHealth Caritas North Carolina will be allowed within 14 calendar days from the date of denial.  A re-review can be initiated via clinical document upload on RadMD.com or the peer-to-peer process. Providers will continue to have the option to submit an appeal if the timeframe to initiate a re-review has passed or the case cannot be approved post re-review.

If you have any questions about our programs, please contact your dedicated Evolent Provider Engagement Manager:

• Brandi Patterson (Advanced Imaging/Cardiology)

Program Update:  Effective March 1, 2026, Evolent will begin managing advanced and cardiac imaging service authorizations for AmeriHealth Caritas VIP Care North Carolina Medicare D-SNP members for dates of service on and after March 1, 2026.  Please refer to the Advanced Imaging Utilization Review Matrix for in-scope services.

Peer-to-Peer Process  

For access to our peer-to-peer process, click here.

Conservative Treatment Forms  

For access to our conservative treatment form, click here.

Low Dose Chest CT History Form

Low Dose Chest CT History Form