Attention Advanced Medical Homes, Carolina Access and CCNC Primary Care Practices
Beneficiary Assignment to Carolina Access/CCNC Primary Care Practices
Eligible Medicaid and NC Health Choice beneficiaries are linked to a Carolina Access/CCNC primary care practice by enrolling with a practice through the local Division of Social Services (DSS) agencies or through NC Tracks auto-assignment.
DSS agencies are responsible for enrolling beneficiaries with the practice of their choice. If a beneficiary does not choose a primary care practice at their DSS, then they will be auto assigned by NCTracks to a primary care practice after receiving additional notifications. The NCTracks auto-assignment process utilizes past assignment information, historic utilization and geography to make assignments.
Beneficiaries receive a Medicaid ID card in the mail with their enrolled primary care practice listed. Carolina Access/CCNC practices receive a per-beneficiary per-month (PMPM) payment for each beneficiary enrolled in their practice. Although not common, Carolina Access/CCNC beneficiary assignments can change from month to month. Carolina Access/CCNC practices should review beneficiary assignment lists each month.
At each visit, a practice should verify the beneficiary’s Medicaid or NC Health Choice eligibility and Carolina ACCESS enrollment for that date of service. This can be accomplished using the Recipient Eligibility Response function in NCTracks. Upon discovery that a beneficiary is not eligible for Medicaid, or is not enrolled correctly for Carolina ACCESS, the practice should refer the beneficiary to the county DSS agency for assistance (see DSS contact information below).
Carolina Access/CCNC Practice Beneficiary Assignment Lists
Medicaid beneficiary panel/assignment information is available to Carolina Access/CCNC practices upon request from Community Care of North Carolina (CCNC) at CCNCSupport@communitycarenc.org or through their local CCNC Network Quality Improvement and Practice Support team.
CCNC is also able to share quality measure results with Carolina Access/CCNC practices. Examples of quality measures tracked by CCNC include well child visits, immunizations, HbA1c testing and asthma medication management.
For a Carolina Access/CCNC practice to receive practice assignment data or quality data, they must have signed the 2-Party Agreement with their CCNC network, as Claims and Eligibility information is state-owned data that CCNC is otherwise unauthorized to share. Practices may obtain the 2-Party Agreement by speaking with their CCNC or CCNC Network Practice Relations Representative.
Managing Beneficiary Assignment at the Practice Level
Practices are encouraged to conduct outreach to assigned beneficiaries who have not been actively engaged in routine primary and preventative care, or who are new to the practice panel. During that outreach, if practices determine that a beneficiary is receiving care at another practice, the practice should encourage the beneficiary to contact their DSS caseworker who can reassign the beneficiary to the correct practice. Beneficiaries can also call the Medicaid Contact Center at 1-888-245-0179 for assistance.
Practices actively caring for beneficiaries who are not assigned to their practice panel are able to help beneficiaries update their practice assignment. Practice staff may complete the Community Care of North Carolina/Carolina ACCESS Enrollment Form for Medicaid Recipient, ask the beneficiary to confirm the change with their signature on the form and fax form to the local DSS office.
Fax numbers and other contact information for the local DSS offices can be found at https://www.ncdhhs.gov/divisions/social-services/local-dss-directory. In instances where issues persist or escalation is needed, practices are encouraged to contact the Medicaid Contact Center at 1-888-245-0179.
Contact
NC Medicaid Contact Center, 888-245-0179