Q. If I am already a Medicaid provider and want to be a CommunityCARE Primary Care Provider (PCP), do I have to enroll in CommunityCARE?

A. Yes. The following provider types may become CommunityCARE PCPs: family practice, general practice, internal medicine, pediatrician, and obstetrician (if willing to provide primary care services for CommunityCARE patients). A CommunityCARE enrollment packet can be downloaded from the Publications and Forms section of this website.

Q. How does CommunityCARE affect providers who are not PCPs?

A. Unless the service provided is an exempt service, the provider must obtain a referral from the PCP in order for Medicaid to pay for the services.

Q. Do all services require a CommunityCARE referral?

A. Most services do require a CommunityCARE referral unless provided by the patient's PCP. However, there are exempt services that do not require a PCP referral. These are listed in the CommunityCARE manual as well as the web site in the Referrals section.

Q. Which Medicaid members will be in CommunityCARE? Is the program voluntary?

A. The program is mandatory for most Medicaid member. There are some members that are exempt from the program, including members who have Medicare, members age 65 or older, and residents of nursing homes. A complete list of exempt categories of members can be found in the CommunityCARE manual as well as Home Page of the web site.

Q. So how do I determine which members are CommunityCARE and which are not?

A. You should check each patient's eligibility using the REVS, MEVS or eMEVS system. If the member is in the CommunityCARE program, the name and telephone number of the PCP will be listed. If no PCP information is listed, the member is not in CommunityCARE. If you are a PCP, you will receive a monthly list (the CP-0-92) that lists your CommunityCARE patients.

Q. I have a large family practice and am not a CommunityCARE PCP. If I don’t enroll in the program , will I lose all my Medicaid patients?

A. Your CommunityCARE patients become linked to a CommunityCARE enrolled PCP and will be required to obtain their primary care from their PCP.

Q. If I am enrolled as a CommunityCARE Primary Care Provider (PCP), do I have to provide KIDMED screenings?

A. You are responsible for KIDMED services for your CommunityCARE patients under age 21. However, you may subcontract the actual screening services to a KIDMED provider(s).

Q. How can a member who has used their twelve annual visits obtain additional visits?

A. The doctor must see the patient and submit the Form 158A AFTER THE VISIT to request approval for payment for the additional visit. The request for extension is reviewed at Unisys, and either approved or disapproved.

Q. How can members who have Medicare or HMO coverage become exempt from participation in the CommunityCARE program?

A. Members who have Medicare or HMO coverage are automatically exempted from the CommunityCARE program if this coverage information is correctly entered on their Medicaid file. If a member who has Medicare or HMO coverage has been enrolled in CommunityCARE, they should submit a copy of their Medicaid card, as well as their Medicare or insurance card, to their parish office so that the insurance information can be correctly entered. The CommunityCARE linkage will close automatically at the end of the month.