Managed Care CCNC/CA FAQs

When you are completing an Enrollment, Re-Enrollment, or Managed Change Request (MCR) for an Individual or Organization, you will be given the option to also enroll as a Primary Care Provider (PCP) in the Community Care of North Carolina/Carolina ACCESS (CCNC/CA) program if your taxonomy qualifies you to participate.

 

NOTE: It is not necessary for individual providers to enroll in CCNC/CA if they are an Attending or Rendering ONLY provider.

Please reference Column J on the Provider Permission Matrix (PPM) to view which taxonomies are eligible to apply for CCNC/CA.

Eligible Community Care of NC/Carolina Access PCPs:

1. Perform primary care services that includes certain preventive & ancillary services
2. Create and maintain a patient/doctor relationship
3. Provide direct patient care a minimum of 30 office hours per week
4. Provide access to medical advice and services twenty-four (24) hours per day, seven (7) days per week
5. Refer to other providers when the service cannot be provided by the PCP
6. Provide oral interpretation for all non-English proficient beneficiaries at no cost

Refer to the How to Enroll, Update, or Terminate CCNC/CA Managed Care Plans job aid on the NCTracks User Guides & Fact Sheets webpage. This job aid provides instructions for Medicaid providers on how to enroll in or terminate participation in CCNC/CA within NCTracks through initial enrollment or by completing a Manage Change Request (MCR).

Providers are not required to obtain authorization from the PCP of record. You do not need approval from the CCNC/CA PCP to treat a Medicaid beneficiary who presents at your practice.

Providers are not required to enter an NPI as the CCNC/CA payment authorization number for claims processing.

To initiate care management services for Medicaid Direct beneficiaries, a CCNC/CA provider may contact Community Care of North Carolina to explore contracting options.

 

For Managed Care, a CCNC/CA approval defaults to Tier 2 participation in the Advanced Medical Home (AMH) program, allowing managed care plans to contract with the provider for primary care services. AMH Tier 2 providers may attest to a higher tier using the AMH Tier Attestation Form. For more information, see the AMH Tier Attestation job aid under Quick Links or the AMH Provider Manual on the DHB Advanced Medical Home webpage.

Yes, you may treat the enrollee.

Contact the NCTracks Call Center at 1-800-688-6696 for assistance.