Community Care of North Carolina (CCNC)
Community Care of North Carolina (CCNC) is a primary care case management entity (PCCMe) for the majority of Medicaid beneficiaries who are enrolled in NC Medicaid Direct.
The Medicaid program aid category determines if a beneficiary is mandatory, exempt (voluntary/optional), or excluded (ineligible) for CCNC enrollment.
For questions regarding CCNC or Carolina ACCESS, contact the NCTracks Call Center at 800-688-6696.
How CCNC Can Help Support Your Care Needs
CCNC provides care management statewide to make sure you get health care services when and where you need them.
As a CCNC member, you have a primary care provider (PCP). Your PCP is a doctor, nurse practitioner or physician assistant who:
- cares for your health
- coordinates your health needs
- refers you to specialists when you need them
You can choose or change your PCP at any time.
As a CCNC member, you may qualify for a care manager. Your care manager:
- helps you understand your Medicaid benefits
- helps connect you to your PCP
- helps arrange your appointments and transportation
- coordinates with your behavioral health providers
- connects you to helpful resources in your community
To learn more about the services CCNC offers, call CCNC at 877-566-0943 or visit the Community Care of North Carolina webpage.
CCNC works with doctors, therapists and other providers to help coordinate your health care needs. You will find a full list of providers in NC Medicaid Direct on the NC Medicaid Enrollment Broker/Find webpage.
If you want to leave CCNC (Disenrollment)
Enrollment in CCNC is mandatory (required) for the people listed below who are in NC Medicaid Direct:
- Most families and children
- Pregnant women
- People who are blind or disabled and do not receive Medicare
This means you will receive care management through CCNC and choose or be assigned to a PCP.
Enrollment in CCNC is voluntary (optional) for the people listed below who are in NC Medicaid Direct:
- Children/youth in foster care
- Children/youth receiving adoption assistance
- Children/youth under age 19 who need special services
- People who receive Medicaid and Medicare
- People who live in nursing facilities
- People who live in Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF-IDD)
- Federally recognized tribal members and individuals who qualify for services through Indian Health Service (IHS)
This means you do not have to receive care management through CCNC or be assigned to a PCP.
If you feel you do not want or need these services, call the NC Medicaid Contact Center at 888-245-0179 to learn more about your choices.
Participation Requirements of New Primary Care Providers (PCPs)
Medical providers interested in serving as a NC Medicaid Carolina ACCESS PCP must complete an online application accessing NCTracks Provider Enrollment.
Applicants must meet all program requirements and qualifications for which they are seeking enrollment before they can be enrolled as an NC Medicaid provider. Provider Permission Matrix
When completing an Individual or Organization Provider Enrollment application, you will be given the option to also enroll as a PCP in the Carolina Access program, if your provider type qualifies you to participate.
An eligible Carolina ACCESS Provider must:
- perform primary care services that include certain preventive & ancillary services
- create and maintain a patient/doctor relationship
- provide direct patient care a minimum of 30 office hours per week
- provide access to medical advice and services 24 hours per day, seven days per week
- refer to other providers when the service cannot be provided by the PCP
- provide oral interpretation for all non-English proficient beneficiaries at no cost
NC DHHS Provider Administrative Participation Agreement
PCPs participating in the Carolina ACCESS network are paid on a fee-for-service basis, plus a Medical Home fee per member per month (PMPM) for coordinating care for each assigned beneficiary. The Medical Home fees are noted as follows:
|Aged, Blind, Disabled (ABD) Medicaid Beneficiaries||$5.00|
|Non-ABD Medicaid Beneficiaries||$2.50|
Existing NC Medicaid Primary Care Providers Interested in the Carolina Access Program
Providers currently enrolled in NCTracks as a NC Medicaid PCP who wishes to join the Carolina ACCESS Program may submit a Managed Change Request (MCR) accessing NCTracks. The submission will be reviewed ensuring all qualifications are met.
Enrolling NC Medicaid Beneficiaries in Carolina Access
NC Medicaid beneficiaries are educated and enrolled in Carolina Access by local Departments of Social Services.
Beneficiaries have freedom of choice when selecting their preferred PCP.
- If a beneficiary is enrolled with another PCP but wants to join your Carolina ACCESS practice, ask them to fill out a CCNC/Carolina ACCESS Enrollment Form for Medicaid Recipients. Mail or fax the completed form to the DSS in the county in which the beneficiary resides.
- If the beneficiary prefers to choose another Carolina Access PCP, refer them to their caseworker at the local DSS office.
NC Medicaid Direct/Managed Care PCP Enrollee Report
To assist with identifying North Carolina Medicaid and NC Health Choice beneficiaries currently assigned under the CCNC/CA program, NCDHHS generated a new NC Medicaid Direct/NC Medicaid Managed Care PCP Enrollee Report for distribution to CCNC/CA participating providers. More information can be found in the NC Medicaid provider bulletin article AMH NC Medicaid Direct/Managed Care PCP Enrollee Report – How to Read & Use Your Enrollee Report.
Care Coordination & Service Referrals
Effective with date of service Nov. 1, 2016, Carolina Access providers shall NOT enter a National Provider Identifier (NPI) as the payment authorization number for claims processing.
Service referral requirements are NOT changing for Carolina Access providers.
Carolina Access PCPs must continue to adhere to care coordination practices as set forth in Section IV of the NC DHHS Agreement for Participation as a Carolina Access Provider. The PCP as the Medical Home will continue to arrange service referrals for medically necessary health care services and specialty care as required by the agreement. For more information, please see the Reminder about Community Care of NC/Carolina ACCESS Payment Authorization in the June 2017 NC Medicaid bulletin.
Care Management Provided by CCNC
Beneficiaries in Medicaid Direct will continue to have care managements services provided by CCNC. Carolina Access PCPs can refer members to CCNC for care management support.
Quality Improvement Support Provided by CCNC
CCNC is also able to share quality measure results with Carolina Access practices for beneficiaries enrolled in NC Medicaid Direct. Examples of quality measures tracked by CCNC include well child visits, immunizations and HbA1c testing. For a Carolina Access practice to receive or continue to receive practice assignment data or quality data, it must sign the new 2-Party Agreement with CCNC, with the exception of Carolina Access providers participating in the EBCI Tribal Option.
Rules for Providers Billing Beneficiaries
Rules and exceptions for providers billing beneficiaries
- AMH NC Medicaid Direct/Managed Care PCP Enrollee Report – How to Read & Use Your Enrollee Report (NC Medicaid Provider Bulletin Article)
- CCNC/Carolina Access Eligible Provider Types
- CCNC/Carolina ACCESS Forms
- CCNC/Carolina ACCESS Provider Agreement
- Community Care of North Carolina
- CCNC Member Handbook
- Enrolling your Medicaid patients into Community Care of North Carolina/Carolina ACCESS
- NC DHHS Provider Administrative Participation Agreement
- New NC Medicaid Direct PCCM Participation Agreement (NC Medicaid Provider Bulletin Article)
- NCTracks Provider Enrollment
- Provider Claims and Billing Assistance Guide
This page was last modified on 11/08/2022