The Care Management Team
Responsible for gathering medication lists and teeing up the member record for the Care Manager
Who is the Pharmacy Assistant (PA)
True or False: We have contracts with multiple payors besides Medicaid.
What is true
About how many members currently have Medicaid in NC
What is over a million +
Number of prepaid health plans (PHPs) with whom CCNC is contracted
What is 5
Name of CCNC's CM documentation platform
What is VirtualHealth (VH) HELIOS
CCNC staff whose primary role is to initiate initial outreach to members
Who are the Member Engagement Specialist (MES) in Complex and Member Care Coordinators (MCC) in the Call Center. Medicare and Commercial CM's do their own initial outreach.
What is the Request for Proposal (RFP)
Number of CCNC regions in NC
What is 6
True or False: Plans are not required to cover basic Medicaid services that beneficiaries received prior to go-live
What is false.
CCNC's intranet
What is CCNC Connects
Also known as the "quarterback" of the member's care team
Who is the Primary Care Manager (PCM)
Required documentation and deadlines CCNC must meet to prevent possible penalties from or losing contracts with the PHPs
What are Service Level Agreements (SLAs)
CCNC's headquarters is located in this Region
What is Region 4
CCNC Staff who support practice-facing work
Who are Provider Relations Representatives (PRRs), the Quality Improvement Practice Support (QIPS) team, VBCC's, and embedded team members
One must be connected to this in order to access CCNC's platforms and private server
What is VPN
Staff with specialized background in behavioral health who supports the PCM when managing members with mental health/behavioral health issues
Integrated Care Coordinator (ICC)
True or False: The RFP and our contracts with the plans require very specific training and education for staff providing CM services to members with Medicaid.
What is true.
Name of the organization that accredits CCNC for our Complex Care Management Program
Who is NCQA. National Committee for Quality Assurance
Date of "Go-Live" for Tailored Plan Care Management
What is July 1, 2024
Drive where one can locate all the Professional Development and Education materials
What is the G:drive
Completes the Comprehensive Medication Review and supports the PCM when managing members with a complex medication regimen
Pharmacist
The two licensed clinicians that can provide CM services to members with Medicaid in NC
What is the RN or LCSW
Our Clinically Integrated Network (CIN) formed in late 2015 to support independent, rural, and small practices
What is Community Care Physicians Network (CCPN)
Timeframes when members are allowed to change plans and/or providers
Within the first 90 days of go-live, after a qualifying event or during open enrollment
System where one enters hours worked or PTO requests
What is ADP