CCPEC Becoming a CCNC Network Provider

Becoming a CCNC Network Provider

Considering becoming a provider with us, or another Community Care of North Carolina (CCNC) network? There are a number of good reasons to do so.

Carolina ACCESS (CA) is our state’s Medicaid managed-care program, and N.C. Medicaid provides Carolina ACCESS I (CA-I) providers with a management fee per patient per month, for Medicaid patients, in return for a practice’s agreement to manage the Medicaid recipients assigned to it. This fee is in addition to a practice’s fee for service payments.

If you join the CCNC network in your area, you have no additional participation requirements beyond those outlined below, which you already satisfy as a Carolina ACCESS I provider.

Community Care Plan of Eastern Carolina (CCPEC) is the CCNC network that serves this region.

Benefits to Your Practice of CCPEC Enrollment

Enrollment will:
    • Increase your CA management fee per Medicaid patient per month.
    • Permit you to make referrals by phone or fax to the CCPEC care manager assigned to your practice. Providers routinely refer patients who have not come back for follow-up care, or those who need additional education about their disease(s) or treatment plan(s), as well as patients who need assistance with medical transportation. A CCPEC care manager can visit the Medicaid recipient in his or her home, and may accompany that patient on medical appointments.
    • Let you participate in CCPEC’s quality-improvement programs.
    • Allow participation in CCNC network initiatives, though participation is always voluntary. CCPEC care managers can provide your practice with tools and educational materials, but it’s always up to you whether you use them.
    • Help you identify patients who are high-cost and high-risk, information that N.C. Medicaid provides all CCNC networks.

Benefit to Your Patients of CCPEC Enrollment

Your patients will receive care-management services in addition to regular services, though they only qualify for this additional Medicaid benefit if linked to a provider who is part of CCNC.

Participation Requirements as a CCPEC Provider

To serve as a primary-care provider (PCP) in CCPEC or any CCNC network, a provider must first be enrolled with the N.C. Division of Medical Assistance (DMA) as a CA Primary Care Provider.

Participating providers will also need to sign a contract with CCPEC.

Additional Participation Requirements

Your practice will:
    • Perform primary care that includes certain preventive services
    • Create and maintain a patient/doctor relationship
    • Establish hours of operation for treating Medicaid patients for at least 30 hours per week
    • Provide Medicaid patients with 24/7 access to medical advice and services
    • Maintain hospital admitting privileges
    • Refer or authorize services to other providers when your practice cannot provide those services to your Medicaid patients

To learn more, or to enroll in CCPEC, contact your area’s regional managed-care consultant.