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Primary Care Case Management (PCCM) is a system of managed care in the US used by state Medicaid agencies, in which a primary care provider is responsible for approving and monitoring the care of enrolled Medicaid beneficiaries, typically for a small monthly case management fee in addition to fee-for-service reimbursement for treatment. [1]
In North Carolina, Medicaid costs are split between the State (34.87%) and the Federal government (65.13%). [13] "Ranking ninth among states in total Medicaid spending, North Carolina's Medicaid program has worked hard not just to cut spending to keep the program solvent, but also to contain costs while improving the quality of health care."
Unlike PPOs, however, HMOs often require members to select a primary care physician (PCP), a doctor who acts as a gatekeeper to direct access to non-emergency medical services, and are required to first obtain a referral from their PCP in order to be reimbursed for the cost of medical services inside of their network of designated doctors and ...
Medicaid is funded by the federal and state governments, which both played a role in unwinding — with states executing the redeterminations and the federal government providing oversight.
Medicaid beneficiaries in North Carolina will soon be able to get GLP-1 drugs like Wegovy, Saxenda and Zepbound covered. NC Medicaid to cover weight-loss drugs like Wegovy, after access cut for ...
More than 700,000 teachers, state employees, dependents and retirees are on the NC State Health Plan. The plan’s insurance carrier is set to change. What NC teachers, state employees, retirees ...
As primary care facilities, RHCs are essential to the health care safety net in rural America. [3] Unlike FQHCs, RHCs are not legally mandated to provide care to patients who cannot pay but many of their patients are uninsured. [4] Recent evidence shows that the presence of RHCs enables greater appointment availability for Medicaid patients. [5]
For medical visits within the health care network, paperwork is usually completed for the patient. If the patient chooses to go outside the network, it is the patient's responsibility to fill out forms, send bills in for payment, and keep an accurate account of health care receipts.