Program Operations

Darryl Frazier - Manager
Phone (919) 647- 8170
Fax (919) 715-0844

Program Operations in conjunction with Customer Services is responsible for the day to day operation of North Carolina's Managed Care programs including Carolina ACCESS—Community Care of NC and Health Check.  Program Operations is comprised of the Program Operations Manager, 6 regional Managed Care Consultants and 2 regional Health Check Consultants.    Specific responsibilities of the unit include:

• Planning, Implementation, Development, and Maintenance of Managed Care and Health Check/EPSDT program initiatives and projects, policies and procedures, research and analysis.
• Lead/Assist in the continuous development of Carolina ACCESS—Community Care of NC. 
• Oversight and Monitoring of Managed Care and Health Check/EPSDT programs and projects.
• Recruitment and Education of primary care providers to participate as Carolina ACCESS primary care providers.
• Assist providers in completing the Carolina ACCESS application and agreement.
• Provide Training and Consulting services to Carolina ACCESS-Community Care of NC participating providers.
• Ensure/Enforce provider compliance with the Carolina ACCESS Agreement.  
• Investigate/Resolve recipient complaints made against Carolina ACCESS providers.
• Assist Carolina ACCESS providers in resolving claim denials related to managed care.
• Review/Approve Budgets and Annual Plans of the Health Check Outreach Projects.
• Conduct Health Check Outreach Project Site-Visits/Reviews
• Direct/Coordinate the work activities of the Health Check Coordinators.
• Review/Monitor each Health Check Outreach Project’s Monthly Accountability/Activities Report.

Additional Resources

• Basic Medicaid Billing Guide
• Regional Managed Care Consultants (53 KB Adobe Acrobat Reader)
• Carolina ACCESS Monthly Enrollment Reports
• Health Check/EPSDT Program

April 4, 2007