Medicaid Doctors In Raleigh Nc


Understand Insurance And Medicare/medicaid

Medicaid in NC Expansion and debate

All visits are billed under Primary Care and are subject to your Primary Care Copay. We accept Medicare and are In-Network with most major insurance providers. Unfortunately we do not participate with Medicaid at this time. If co-payments are required by your insurance plan, this will be collected in full prior to your appointment at check in. If you are not able to pay your co-payment, it may be necessary to reschedule your appointment. It is also important to be aware that not all services are covered through insurance plans. If your insurance company determines that a service is not covered, it will be your responsibility to pay the remaining balance.

Family And Childrens Medicaid

  • Covers children through age 20, parents and caretakers of minor children under the age of 18, and pregnant women who meet income requirements.
  • Family Planning Program is designed to reduce unintended pregnancies and improve the well-being of children and families. Services are provided to eligible persons of any age who are ineligible for all other Medicaid programs.
  • North Carolina Health Choice Health Insurance for Children provides reduced price comprehensive coverage for children six to 18 years whose family income meets certain limits but is too high to qualify for Medicaid.

A Pioneering Approach To The Old

With 125 top clinicians making more than 160,000 housecalls to patients in homes, apartments, hotels, workplaces and senior resident/assisted living facilities, Doctors Making Housecalls is North Carolinas leading provider of home-based primary care. We care for patients from 3 to 103, with a particular focus on keeping complex, frail and elderly patients well and out of the hospital.

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Recommended Reading: What Is Family Planning Medicaid Nc

What Is Family Medicine

A certification by the Board of Family Practice practitioners prevent, diagnose, and treat a wide variety of ailments in patients of all ages, placing special emphasis on the care of families on a continuing basis. They have received a broad range of training that includes surgery, psychiatry, internal medicine, obstetrics and gynecology, pediatrics, and geriatrics.

Nc Medicaid Managed Care Launches

North Carolina doctors, Governor Pat McCrory meet to back ...

Starting July 1, nearly 1.6 million Medicaid beneficiaries in North Carolina began receiving the same Medicaid services in a new way through NC Medicaid Managed Care health plans. Most beneficiaries are still getting care from the same doctors they saw previously, but they are now a member of a health plan. Some beneficiaries did not enroll with health plans and are remaining in NC Medicaid Direct.

Also Check: Medicaid Cost Sharing With Medicare

Inside North Carolinas Big Effort To Transform Health Care

  • Read in app

By Steve Lohr

RALEIGH, N.C. North Carolina seems like an unlikely laboratory for health care reform. It refused to expand Medicaid coverage under the Affordable Care Act, and ranks in the bottom third among states in measures of overall health.

But the state has embarked on one of the countrys most ambitious efforts to transform how health care is defined and paid for.

North Carolina is in the early stages of turning away from the traditional fee-for-service model, in which doctors and hospitals are paid for each office visit, test or operation. Instead, providers will often be paid based on health outcomes like controlling diabetes patients blood sugar or heart patients cholesterol. The better the providers do, the more they can earn. If they perform poorly, money could eventually come out of their pocket.

The goal is to keep people healthy and out of the hospital and to save money on health care spending.

The idea is not new, as some hospital systems and other states have moved toward paying based on outcomes. Some were prodded by federal incentives. The evidence so far is mixed, with more success improving the health of some patients than cutting overall costs.

The North Carolina project is the biggest bet yet on the concept. It is being championed by the states Department of Health and Human Services, which oversees payments for Medicaid, and Blue Cross Blue Shield of North Carolina, the states largest private insurer.

Orthopedic Specialists In Hand Wrist Elbow And Shoulder Care In Raleigh Nc

COVID-19 Update If you have fever, shortness of breath, cough, chills, trouble breathing, loss of taste or smell, flu-like symptoms or have been exposed to someone with COVID-19, please reschedule your appointment. We require all staff, patients and visitors to wear a mask or face covering in our office.

The Raleigh Hand to Shoulder Center has treated patients in North Carolina for over 30 years. While our name may be new, it better reflects what we have been doing for years caring for patients of all ages with hand, wrist, elbow, and shoulder problems.

The practice combines the experience of 6 board-certified orthopedic hand and upper extremity surgeons as well as certified hand therapists and physical therapy.

For patients with emergencies, the Raleigh Hand to Shoulder Center is on-call 24 hours per day, 7 days a week. Patients with urgent problems can often be seen by a doctor on the same day or next day. From minor cuts to major injuries of the hand, wrist, elbow and shoulder, the physicians and therapists aim to restore function and improve quality of life. The doctors are among the best in their field of hand surgery and several have been named top doctors.

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Behavioral Health Crisis Line

If you are experiencing a behavioral or mental health crisis, please call . Carolina Complete Health has clinicians available to speak with you 24 hours a day, seven days a week. They can connect you to the support you need to help you feel better. If you are in danger or need immediate medical attention, please call 911.

Medicaid And Nc Health Choice Provider And Health Plan Lookup Tool

NC Medicaid change results in delayed payments for some small healthcare providers

You can use the Medicaid and NC Health Choice Provider and Health Plan Lookup Tool to find a primary care provider . Our new provider search will help you find the best PCP for you and your family.

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Prior Authorization And Notification Resources

Dual Complete Program

UnitedHealthcare Community Plan of North Carolina offers a Dual Special Needs Plan UnitedHealthcare Dual Complete , a state wide Medicare Advantage program.

Phone: 800-638-3302 available 8 a.m. to 6 p.m. Eastern Time

North Carolina Provider Contracting

UnitedHealthcare Community Plan of North Carolina

3803 N. Elm Street

Optum Behavioral Health – Phone: 877-614-0484 or email:

Optum Behavioral Health Providers – email:

NC Provider Relations – email:

Pharmacy Service Line

Join Our Network

To contract with the Community Plan of North Carolina Medicaid please contact the NC Health Plan Provider Call Center at 800-638-3302.

Behavioral Health Providers

Learn how to join the Behavioral Health Network, review Community Plan Behavioral Health information, or submit demographic changes at Community Plan Behavioral Health, you may also contact Optum Behavioral Health at 877-614-0484.

Facility/Hospital-Based Providers, Group/Practice Providers and Individually-Contracted Clinicians

The state-specific requirements and process on how to join the UnitedHealthcare Community Plan network is found in the UnitedHealthcare Community Plan Care Provider Manuals.

The Centers for Medicare & Medicaid Services established the Medicaid Managed Care Rule to:

Member Information: Current Medical Plans, ID Cards, Provider Directories, Dental & Vision Plans

Plan information is available for:

  • Dual Complete Program
  • Medicaid

Primary Care Doctor Locations In North Carolina

Find a Medicare doctor nearyou at one of our many primary care centers for seniors in NorthCarolina. Our state-of-the-art primary care centers provide access toseniors who need it most. With locations throughout the state in:Raleigh, Durham, High Point, Greensboro, Winston Salem, Charlotte, andeven more centers coming soon. Our Medicare primary care physiciansprovide patients with high-quality care, spending more time getting toknow your history so they can provide a healthcare journey suited toyour needs. Our in-center community rooms support Medicareeducation events, as well as a variety of activities to help promote acommunity feel for our patients, such as: yoga, dancing, painting,Bingo, and other entertainment.

We offer telehealth for seniors who cant make it into thecenter to see their doctor, as well as transportation to and from doctorappointments for patients who qualify. Our primary healthcare centerseven house their own in-center labs to make it easier for patients toget a variety of health screenings including immunizations.

Our Medicare clinics in North Carolina accept Cigna,Humana, Medicaid, Medicare, Medicare Advantage, UnitedHealthCareinsurance, and more. And our patient relations manager can work with youto help make sure you are getting the most out of your insurance plan.We look forward to working with you toward your health goals.

Recommended Reading: Wellcare Of North Carolina Medicaid

Focus On Primary Care

Primary care clinics like the Ardmore Family Practice in Winston-Salem are at the front line of the North Carolina campaign. Their physicians and nurses are expected to play a larger role in managing care, and stand to gain financially.

In some ways, the small Ardmore clinic has long been doing some of the things the new push supports.

It has built deep roots in the community. Dr. Robert Rosen, one of the physicians, delivered Catherine Vickers, an assistant practice manager in the office, 24 years ago. The other Ardmore physician, Dr. Amy Sapp, describes her work as firsthand longitudinal health care, taking care of people over years, knowing them, their families, their living circumstances and their life changes.

The new payment model pushes them to do even more on both fronts and do it in a more systematic way, like asking patients detailed screening questions about depression, alcohol consumption, food and housing. So on annual wellness visits, the doctors now spend more time with patients, and receive an extra $20 in addition to the clinics standard charge of about $150.

In total, the states changes are likely to increase the share of total health care dollars that go to primary care physicians as opposed to specialists, hospitals and other places to 10 to 13 percent from 6 to 8 percent over several years, according to estimates by health policy experts.

Your Time Matters Choose Heritage


We offer a range of services, including management of chronic disease, ongoing illness follow-up care, and if necessary, referral coordination to high value specialists. Our clinic offers same day primary care appointments and immediate walk-in availability and can provide you and your family with a range of health services, including urgent, acute, immediate, and walk in health care needs. We also provide services during early morning hours and after hours and during the weekend. To ensure you receive high quality care, our office utilizes state of the art facilities and equipment, including a large procedural room for performing procedures such as orthopedic splinting and/or wound repairs. Our clinic can also take on-site digital x-rays and work with local imaging centers to perform a wide array of diagnostic exams, including CT scans and/or ultrasound. We also perform a broad range of laboratory services for onsite and send out labs, and can perform gynecologic testing and exams, pregnancy tests, urinalysis, vaccines, rapid flu tests, and strep tests.

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Medicaid And Health Choice Dental Providers

Beneficiaries have two choices to find a dentist in North Carolina.

To find a dentist in North Carolina using the Insure Kids Now Website , please use the following link:

IMPORTANT: Before making an appointment, please call the dental office to verify that beneficiaries are currently being accepted. A dentist or facility shown on the list is not a guarantee that beneficiaries are currently accepted.

To find a dentist in North Carolina using the Medicaid and NC Health Choice Provider and Health Plan Lookup Tool, please use the following link:


  • If you know the provider by their last name, search by Provider for a Plan. Enter at least a portion of the last name, a location, and use the specialty drop down to choose the type of dental provider to search.
  • If you know the practice name where the provider works, search by Organization for a Plan. Enter at least a portion of the practice name, a location, and use the specialty drop down to choose the type of dental provider to search.
  • If you do not know the PCP you want to choose, go to Search by Health Plan for an Organization. Select NC Medicaid Direct in the Health Plan field, a location, and use the specialty drop down to choose the type of dental provider to search.
  • If you use this option to find a new dentist, you must still call the Medicaid Contact Center or your local DSS office to ask for the change.

Cost Of Care Transparency At Heritage Urgent & Primary Care

A visit to the emergency room or hospital can cost a substantial amount of money and take much longer for you to receive the care you need. At Heritage Urgent & Primary Care, our board-certified providers can provide you with high-quality care in a timely and cost-effective manner. If you require health services and are concerned about the cost involved, please refer to the following overview of our clinics policies. If you have any additional questions concerning billing, insurance, and/or payment options, please contact our staff.

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A Message From Dmhc Regarding The Coronavirus

The advantages of caring for patients at home the practice model DMHC pioneered are now more apparent than ever. Under current circumstances, there is nothing more important for frail elders than having primary care clinicians and the healthcare professionals who support them, continue providing care in their home. It is imperative to actively manage our patients multiple medical problems, while keeping them out of crowded waiting rooms full of sick people.

About Us

Nc Medicaid Managed Care Excluded

Welcome to NC Medicaid Managed Care (30)
  • Some beneficiaries will remain in NC Medicaid Direct, which is the fee-for-service program. This is how you receive health care services now. This means you cannot choose a health plan and you do not need to choose a new PCP unless you want to change to your current PCP. You will stay in NC Medicaid Direct if you:
  • Receive Family Planning Medicaid, Refugee Medicaid, Foster Care/Adoption Medicaid , or must meet a deductible before getting Medicaid benefits
  • Are part of the Health insurance premium payment or Program of all-inclusive care for the elderly programs, or
  • Have both Medicare and Medicaid or receive long-stay nursing home services,
  • Receive Innovations Waiver services, Traumatic Brain Injury Waiver services, or Community Alternatives Program for Children or Community Alternative Program for Disabled Adults services.

Recommended Reading: Best Way To Apply For Medicaid

New Tack For Big Providers

This year, Blue Cross announced that it had signed five of the largest health systems in the state to contracts linking payments to total costs of care for their patient populations and quality measurements, not to hospital stays or surgical procedures.

Duke University Health System is one of those big groups. Its so clear that change is necessary, said Dr. Thomas Owens, president of Duke University Hospital in Durham.

In the new contracts, a provider is paid a set amount, typically a monthly fee per patient. How to spend and save money is largely up to the provider. That could open the door to a new relationship with payers, including insurers, Dr. Owens said, since there should not be a fight over approving each test or treatment, a daily torment for doctors in the fee-for-service world.

Over time, fewer members of the Duke staff may be employed in the adversarial work of billing and payment and more people can work on health care, he said.

Duke has made several efforts in recent years to curb costs through health practices, including pushing preventive programs and prescribing generic drugs, Dr. Owens said. A depression screening and counseling program, he noted, reduced the recurrence of symptoms by 50 percent within a year. Duke will continue and expand such programs, he said.

Nc Medicaid Managed Care Exempt

Some beneficiaries can choose to stay in NC Medicaid Direct. This means you are not required to choose a health plan and a PCP. NCDHHS – Division of Health Benefits will send you a letter that tells you if you have the choice to enroll. You have the option to choose a health plan if you:

  • Are a federally-recognized tribal member or individual eligible for services through Indian Health Service .
  • Need certain services to address needs related to developmental disability, behavioral health or traumatic brain injury. BH covers MH and SUD

If you are transitioning to NC Medicaid Managed Care and want to keep the PCP you have now:

  • Choose a health plan that your provider works with. If you have questions about the instructions in the letter you received ,

To find a doctor, go to Find a provider.

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Medical Standards Of Care And Clinical Practice Guidelines

If you want to research the clinical practice guidelines for a disease, condition, treatment or intervention or for health services administration, you can browse them online here. Your prescription in determining the standards of care and clinical guidelines applicable to your cases. Medical standards of care and clinical practice guidelines are established by a consensus of health care professionals as diagnostic and therapeutic actions or behaviors that are considered the most favorable in affecting the patients health outcome. The Internet offers a wide variety of expert consensus and evidence-based standards and guidelines, which provide insight, on a national level, to a broad scope of medical practice. Additionally, standards of care are established through, state and federal regulations, institutional policy & procedures, expert witnesses and literature. These links will lead directly to the pertinent sections on standards, guidelines, or position statements.


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