Skip all navigation Skip to page navigation

DHHS Home | A-Z Site Map | Divisions | About Us | Contacts | En Español

 
NC Department of Health and Human Services
NC Division of
Medical Assistance
 
 

Managed Care


Community Care of North Carolina/Carolina ACCESS (CCNC/CA) is the primary care case management health care plan for a majority of Medicaid citizens of this state. The objective of CCNC is to create community health networks to achieve long-term quality, cost, access and utilization objectives.

Managed Care Sections

The Managed Care section oversees the Managed Care Customer Service Unit, Program Operations, Risk Contract, and Health Check.

Managed Care Customer Service Unit

DMA's Managed Care Customer Service Unit provides information to callers regarding Medicaid covered services or resources that are available to help resolve problematic issues and/or navigate the Medicaid health care system. A majority of callers are Medicaid recipients; however, service providers also call for assistance with situations that involve the delivery of care to Medicaid recipients.

The Customer Service (CS) Unit creates, reviews, and analyzes reports used to track program status and performance.

 

Program Operations

Program Operations in conjunction with Customer Services is responsible for the day to day operation of North Carolina's Managed Care programs including CCNC/CA and Health Check. Specific responsibilities of the unit include:

  • Planning, Implementation, Development, and Maintenance of Managed Care and Health Check/EPSDT program initiatives and projects, policies and procedures, research and analysis.
  • Lead/Assist in the continuous development of Carolina ACCESS—Community Care of NC.
  • Oversight and Monitoring of Managed Care and Health Check/EPSDT programs and projects.
  • Recruitment and Education of primary care providers to participate as Carolina ACCESS primary care providers.
  • Assist providers in completing the Carolina ACCESS application and agreement.
  • Provide Training and Consulting services to Carolina ACCESS-Community Care of NC participating providers
  • Ensure/Enforce provider compliance with the Carolina ACCESS Agreement.
  • Investigate/Resolve recipient complaints made against Carolina ACCESS providers.
  • Assist Carolina ACCESS providers in resolving claim denials related to managed care.
  • Review/Approve Budgets and Annual Plans of the Health Check Outreach Projects
  • Conduct Health Check Outreach Project Site-Visits/Review

Health Check

North Carolina expanded the federal Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program (which has been in existence since Medicaid began) to form the Health Check program in 1993. EPSDT serves as the standard for providing healthcare to Medicaid recipients under the age of 21. The purpose of the Health Check program is to facilitate regular preventive medical care and the diagnosis and treatment of any health problem found during a screening. There is no separate enrollment in Health Check. If someone is eligible for Medicaid and is under the age of 21, they automatically receive Health Check services.

Health Check Automated Information and Notification System (AINS)

Health Check Strategies

The following Health Check strategies have been implemented statewide:

  • Changes in state program administration to help integrate policies and procedures so both financing and service delivery objectives are compatible among State agencies.
  • Changes in local administration to improve coordination among local agencies, improve outreach to families and providers, and to assist families in obtaining needed health services.
  • Implementation of a statewide outreach campaign and toll-free hotline to educate parents about the availability of services and the importance of regular care.
  • Design and implementation of an automated information and notification system to provide families, caregivers and Health Check Coordinators with information regarding program participation.
  • Expansion of coverage for special services.

Health Check Coordination Services

An integral part of the Health Check Program is a special initiative called Health Check Coordination Services. This program is operational in all 100 counties Statewide, and consists of specially trained Health Check Coordinators working to reduce barriers and improve access to preventive health services. The Division of Medical Assistance works in close collaboration with the Division of Public Health’s (DPH) Women’s and Children’s Health Section to provide guidance to the project counties.

Health Check Reports

More Information on the Health Check Program

 

 

August 3, 2011