What if my Carolina ACCESS panel members need specialized health care services that my office cannot provide?
Primary Care Providers (PCPs) are responsible for referring Carolina ACCESS enrollees to specialists and other health services as needed. Medicaid will only pay for Medicaid covered services if the PCP authorizes treatment, except for the exempt services. A list of these exempt services can be found in the Managed Care Provider Information section of the Basic Medicaid Billing Guide. When authorizing treatment, the PCP must give the treating specialist or provider his NPI number. CA enrollees may be referred to any specialist who accepts Medicaid. Be sure to identify your patient as a CA enrollee when making the referral. In most situations, authorization should be given prior to services being rendered. However, authorization may be granted in other situations at the PCP’s discretion. Authorization for referrals may be given by telephone or in writing. It is recommended that PCP’s store documentation on all CA referrals for internal tracking purposes and quality of care issues. This c
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