Community Care of North Carolina/Carolina ACCESS

Community Care of North Carolina/Carolina ACCESS (CCNC/CA) is a primary care case management health care plan for a majority of Medicaid beneficiaries in North Carolina. The program aid category determines if a beneficiary is mandatory, optional or exempted from CCNC/CA.

Participation Requirements of Primary Care Providers (PCPs)

Medical providers interested in serving as a Carolina ACCESS PCP must complete an online application or Managed Change Request through NCTracks.

NCTracks Enrollment

An eligible CCN/CA provider must:

  • Perform primary care that includes certain preventive services
  • Create and maintain a patient/doctor relationship
  • Establish hours of operation for treating patients for at least 30 hours per week
  • Provide access to medical advice and services 24x7
  • Maintain hospital admitting privileges
  • Refer or authorize services to other providers when the service cannot be provided by the PCP
  • Provide oral interpretation for all non-English proficient beneficiaries at no cost

To serve as a PCP in a CCNC/CA network, a provider must first be enrolled with DMA as a Carolina ACCESS PCP. Providers are required to sign a contract with the local network. Contact the regional managed care consultant for more information.

Enrolling Medicaid and NCHC Patients in CCNC/CA

Patients do not have to choose you, the provider, as their health home. If they prefer to choose another provider or do not want to enroll, refer them to their caseworker at the county Department of Social Services (DSS) office.

If a patient is enrolled with another provider but wants to join your practice, ask them to fill out an enrollment form. Medicaid beneficiaries are enrolled in CCNC/CA by the DSS office in the county where they reside.

Exceptions to the Mandatory Program Aid Categories

  • Any Medicaid beneficiary who receives Medicare and Medicaid becomes optional for enrollment
  • Anyone under the age of 21 years who is identified as having special needs becomes optional for enrollment. “Special needs” is defined as any one of:
    • A child receiving SSI
    • A child in foster care or receiving adoption assistance
    • An individual who self-identifies as having special needs
  • Current or potential enrollees who are in the mandatory program aid category can request an exemption from participation for medical reasons. Beneficiaries can request exemption request forms from the county DSS office.

Referrals and Exemptions

If the PCP is unable to provide the necessary services, the PCP is then contractually obligated to refer patients or authorize treatments. To refer or authorize a service:

  • The PCP's authorization number must be communicated to the service provider
  • The PCP defines the scope of a referral , including the number of visits being authorized and the extent of the diagnostic evaluation
  • The PCP should be informed if a secondary referral, sending patient to a second provider for the same diagnosis, should be made
  • A provider who has received a referral should consult the PCP before referring to a secondary provider The PCP may authorize care retroactively (at the discretion of the PCP)

If a non-PCP provider has provided a service and is denied authorization by the PCP, the service provider may request an override. To request an override the provider must contact the Medicaid fiscal agent. Contact information is provided on the form.

Carolina ACCESS Override Request Form

Women, Infant and Children (WIC) Supplemental Nutrition Program

CCNC/CA PCPs are required to refer potentially eligible enrollees to the WIC program. County WIC programs are administered statewide through county health departments, community and rural health centers, and community action agencies.

Provider Forms

CA Provider Participation Agreement

Medicaid CCNC/CA Office Enrollment Guidelines

CA Provider Enrollment Application

Health Check Agreement Between Primary Care Provider and the Local Health Department

CCNC/Carolina ACCESS Member Handbook - English / Spanish

More Information

CA Teaching Tool

Contact

Network Phone Number
AccessCare
Alamance, Alexander, Alleghany, Ashe, Avery, Burke, Caldwell, Caswell, Catawba, Chatham, Cherokee, Clay, Graham, Haywood, Iredell, Jackson, Macon, Orange, Robeson, Sampson, Swain, Watauga, Wayne

919-380-9962

Carolina Collaborative Community Care
Cumberland

910-485-1250

Carolina Community Health Partnership
Cleveland, Rutherford

704-484-5216

Community Care of the Lower Cape Fear
Bladen, Brunswick, Columbus, New Hanover, Onslow, Pender

910-763-0200

Community Care of Wake and Johnston Counties
Johnston, Wake

919-783-0404

Community Care of Western North Carolina
Buncombe, Henderson, Madison, McDowell, Mitchell, Polk, Transylvania, Yancey

828-348-2818

Community Care Partners of Greater Mecklenburg
Anson, Mecklenburg, Union

704-512-5555

Community Care Plan of Eastern Carolina  

Carteret, Craven, Duplin, Jones, Pamlico

252-636-4962

Edgecombe, Greene, Lenoir, Pitt

252-847-7476

Halifax, Hertford, Nash, Northampton, Wilson

252-847-0067

Beaufort, Bertie, Camden, Chowan, Currituck, Dare, Gates, Hyde, Martin, Pasquotank, Perquimans, Tyrrell, Washington

252-847-6430

Community Health Partners
Gaston, Lincoln

704-853-5069

Northern Piedmont Community Care  

Durham

919-613-6512

Franklin, Granville, Person, Vance, Warren

252-430-0360

Northwest Community Care Network
Davie, Davidson, Forsyth, Stokes, Surry, Wilkes, Yadkin

336-716-5654

Partnership for Community Care
Guilford, Randolph and Rockingham

336-235-0930

Community Care of the Sandhills
Harnett, Hoke, Lee, Montgomery, Moore, Richmond, Scotland

910-246-9806

Community Care of Southern Piedmont
Cabarrus, Rowan, Stanly

704-262-1041

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