The PCP is key to the ability to achieve the goals of CCNC/CA. A medical provider who is interested in serving as a Carolina ACCESS PCP must complete an application for participation. The application will be reviewed by the Provider and Recipient Services Section at DMA who notifies the applicant if the application is approved or denied and the reason for the denial. If for any reason a candidate does not or cannot meet these criteria, an exceptions’ review will be done. An exception may be granted if it is determined that access to care for Medicaid recipients would be impeded if all criteria are not met. Each request for an exception is evaluated on an individual basis.
A candidate for participation must meet the criteria below:
- Perform primary care that include certain preventative services
- The ability to create and maintain a patient/doctor relationship for the purpose of providing continuity of care
- Establish hours of operation for treating patients at least 30 hours per week
- Provide access to medical advice/services 24/7
- Maintain hospital admitting privileges or have a formal agreement with another doctor based on ages of the members accepted
- Refer or authorize services to other providers when the service cannot be provided by the PCP
- Use reports provided by the DMA managed care section as guides in maintaining the level of care that meets the goals of CCNC and patient needs. Reports are available via the web and paper copies that are mailed.
In order to serve as a PCP in a CCNC/CA network, the provider must first be enrolled with DMA as a Carolina ACCESS PCP. An interested provider may contact the regional managed care consultant for more information. The provider will be required to sign a contract with the local network.