Community Care of North Carolina/Carolina ACCESS (CCNC/CA)
Community Care of North Carolina/Carolina Access (CCNC/CA) is a primary care case management (PCCM) health care plan for a majority of Medicaid & Health Choice (NCHC) beneficiaries in North Carolina. About CCNC/CA
The Medicaid program aid category determines if a beneficiary is mandatory, optional or ineligible for CCNC/CA enrollment.
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. NCTracks Provider Enrollment
Applicants must meet all program requirements and qualifications for which they are seeking enrollment before they can be enrolled as a 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 Primary Care Provider (PCP) in the Carolina Access program, if your provider type qualifies you to participate. CCNC/CA Eligible Provider Types
An eligible Carolina Access Provider must:
- Perform primary care services that includes 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 twenty-four (24) hours per day, seven (7) 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
Existing NC Medicaid Primary Care Providers Interested in the Carolina Access Program
Providers currently enrolled in NCTracks as a NC Medicaid Primary Care Provider whom wish 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 Submit an MCR.
Primary Care Providers Partnering with CCNC Networks
Once enrolled as a Carolina Access PCP, providers may inquire on serving as a PCP in the NC Medicaid’s enhanced PCCM program known as Community Care of North Carolina (CCNC). To participate, providers are required to sign a separate contract with the local CCNC network. Carolina Access PCP’s who wish to participate in the CCNC program should contact the CCNC Network serving their county.
PCP’s participating in the CCNC network are paid on a fee for service basis, plus an enhanced per member per month care management (PMPM) for each assigned beneficiary. The enhanced fees are noted as follows:
|ABD Medicaid Beneficiaries (Aged, Blind, Disabled)||$5.00|
|Non ABD Medicaid Beneficiaries||$2.50|
|NC Health Choice Beneficiaries||$2.50|
Enrolling NC Medicaid and NCHC Beneficiaries in CCNC/CA
Medicaid beneficiaries are educated and enrolled in CCNC/CA by the local Department of Social Services (DSS) office.
Beneficiaries have freedom of choice when selecting his/her preferred primary care provider. If a beneficiary is enrolled with another provider but wants to join your CCNC/CA practice, ask them to fill out a CCNC/CA Enrollment Form for Medicaid Recipients. Mail or fax the completed form to the Department of Social Services in the county in which the beneficiary resides.
If the beneficiary prefers to choose another CCNC/CA provider, refer them to their caseworker at the local DSS office.
CCNC/CA Service Referrals & Care Coordination
Effective with dates of service Nov. 1, 2016, Community Care of North Carolina/Carolina Access (CCNC/CA) providers shall NOT enter a National Provider Identifier (NPI) as the CCNC/CA payment authorization number for claims processing.
Providers should not receive claims denials due to CCNC/CA payment authorization for dates of service after Oct. 31, 2016.
Service referral requirements are NOT changing for CCNC/CA providers
Providers are encouraged to continue supporting the CCNC/CA program which is designed to improve quality and access to care; manage appropriate utilization of services; and achieve cost-effectiveness through care coordination with CCNC/CA Primary Care Providers.
CCNC/CA Primary Care Providers (PCPs) must continue to adhere to care coordination practices as set forth in Section IV of the NC DHHS Agreement for Participation as a CCNC/CA Provider. The PCP in the medical home will continue to arrange service referrals for medically necessary health care services and specialty care as required by the Agreement.