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The county DSS is responsible for maintaining the provider directory .The county may designate who maintains the directory. For example, it may be the CCNC/CA contact, a Medicaid supervisor or caseworker, or administrative or clerical staff.
The directory must be maintained in two formats. Maintain one directory for Income Maintenance Caseworkers (IMCs) to use to enroll recipients in CCNC/CA. This directory includes the provider number. Maintain a second directory to mail to the recipients to choose a medical home. This directory does not include the provider number.
On the directories, identify the provider as either a CA1 (CA, shown on the MP screen as CACC) or a CA11 (CCNC, shown on the MP screen as CCNC).
REISSUED 12/01/11 - CHANGE NO. 20-11
(VI.)
It is very important to maintain a current and accurate county directory to assure recipients are linked with an appropriate Primary Care Provider (PCP). For example, do not enroll a new patient with a provider who only accepts established patients, or do not enroll a recipient who is under age 20 with a provider who does not see patients under age 20.
Each county may customize the provider directory to meet its needs. For example, you may choose to list providers by specialty, availability, location, restrictions, etc. DMA provides the following tools for the county to maintain the directory.
The county caseworkers must utilize the existing CCNC/CA Provider Directory for enrollment of Medicaid or NCHC children.
The Provider Directory and Availability Reports are indexed by county. To select the report for just your county, follow these steps:
From the V22: Latest Report, key an "X" to the left of the report name From the V15: Report Name, key an "S" to the left of COUNTY$. Use F7/F8 to page backward/page forward to find your county. Key an "S" to the left of your county number. Refer to EIS 1061, XPTR Report Distribution System, for complete instructions to access reports on NCXPTR including how to browse reports and options available while browsing.
EIS has three Carolina ACCESS Primary Care Provider Information Screens, (MP). These screens contain all information necessary to enroll individuals in CCNC/CA including availability and restrictions. It is very important to verify the restrictions on the MP screens to link recipients appropriately. The restrictions are listed below.
01 No restriction
02 Established patients only
06 MPW only
REVISED 12/01/11 - CHANGE NO. 20-11
(VI.B.)
07 Nephrology patients only (in same or contiguous counties)
08 Chronic infectious disease patients only (in same or contiguous counties)
09 Oncology patients only (in same or contiguous counties)
10 Established patients and siblings
11 Newborn only
14 Two track clinics; facilities serving two distinct populations
15 Age restrictions- refer to Notepad (PF 4/16) on MP Screen in EIS
The Provider Services Section faxes a weekly list to the county CCNC/CA Contact, summarizing changes in the Provider Directory. The CCNC/CA Contact is responsible for forwarding the update to the person who maintains the directory.
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For questions or clarification on any of the policy contained in these manuals, please contact your local county office. |
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