NC DMA: Managed Care Customer Service Unit

Division of Medical Assistance
Providing access to high quality, medically necessary health care for eligible North Carolina residents through cost effective purchasing of health care services and products.

Managed Care Customer Service Unit

DMA's Managed Care Customer Service Unit provides information to callers regarding Medicaid covered services or resources that are available to help resolve problematic issues and/or navigate the Medicaid health care system. A majority of callers are Medicaid recipients; however, service providers also call for assistance with situations that involve the delivery of care to Medicaid recipients.

The Medicaid Ombudsman is part of the Customer Service unit and works closely with other sections within DMA to ensure current and accurate information is provided. The ombudsman is bilingual and handles calls where Spanish is the preferred language. The ombudsman responds to many of the inquiries made to Office of Citizen Services by North Carolina citizens when Medicaid is the subject of inquiry. There is a close collaboration with the Office of Citizen Services to coordinate the Medicaid information being given to citizens who call the CARE-LINE. The ombudsman also keeps the CARE-LINE updated on Medicaid covered services so that they have the information to handle basic Medicaid inquiries.

The CARE-LINE refers Medicaid calls that are more complex to the CS unit. The CS unit collaborates with CA/CCNC networks on quality health initiatives to improve the education and distribution of information to Medicaid recipients.

Customer Service Representatives also work with local departments of social services to maximize enrollment by contacting eligible Medicaid recipients and enrolling them into the Carolina ACCESS program. The outreach effort was piloted in Cumberland County. Currently, outreach counties are working with 3 counties: Orange, Caswell, and Gaston.

The Customer Service (CS) Unit creates, reviews, and analyzes reports used to track program status and performance.

CS partners with program operations in identifying the necessity and scope of program policies and procedures. CS has a in developing or modifying and implementing policies that enhance access to necessary and quality health care for recipients of Medicaid.