Introducing Optima Family Care of North Carolina

Medicaid In NC

Medicaid is transforming in North Carolina

In 2019, the current fee-for-service model in North Carolina moves to a Managed Care approach. Provider Led Entities (PLEs) are being formed to help manage the care of beneficiaries within this new model.

Optima Family Care of North Carolina, part of the Sentara Healthcare family, has submitted a license application to the North Carolina Department of Insurance and plans to locally operate a Provider Led Entity.

Sentara Healthcare is a nationally respected Managed Care Organization with more than 127 years’ experience operating hospitals and provider groups.

A Proven Model

A proven model of Medicaid care delivery

Optima Health, in collaboration with local providers, is a leader of Medicaid Managed Care efforts in Virginia.

Since 1997, Optima Health has served Virginia’s Medicaid recipients. Currently, we are providing services to 185,000 members in Virginia.

How We Work

Optima Family Care of North Carolina

Will partner with local providers to remove barriers and expand access to medical care in North Carolina, including implementing preventive programs created specifically for rural populations.

Will create an advisory committee, made up of local providers, to ensure providers have an opportunity to share their vision for the PLE and its outcome for beneficiaries.

Will be operated locally, and with guidance from North Carolina Medicaid providers and advisory members, to determine how Medicaid dollars are spent in the state.

Our Results

Transforming care in North Carolina at our Sentara Albemarle Medical Center since 2014

Patient care improvements

Launched Meds to Beds bedside medication delivery in partnership with Todd’s Pharmacy

Improved patient satisfaction in hospital departments and emergency department to meet community expectations

Hired a patient navigator to assist orthopedic and oncology patients

Decreased rate of patient readmission by providing the right care, at the right time, and in the right place


New Healthcare providers hired in 2016 for local patients

2
General Surgeons
1
General Surgery PA
2
Ortopedic Surgeons
1
Anesthesiologist
1
Critical Care Intensivist
3
Primary Care Providers
4
Urgent Care Providers
2
Pediatricians

Our rural Initiatives

Low-dose CT lung screenings to help detect lung cancer earlier

Sentara Living health education series for those 50 and older

Tele-stroke program to provide care to stroke patients faster

Decreased wait from a mammogram to biopsy

$30 million in local charity care

Partner With Optima Health

It’s easy to partner with Optima Family Care of North Carolina

Our Provider Connection portal is a self-service, online provider tool available 24 hours a day, 7 days a week, that offers:
  • Drug formularies and pharmacy authorization forms
  • Medical authorization forms
  • Easy enrollment for Electronic Funds Transfer (EFT)
  • Provider manuals
  • Provider newsletter and important updates
  • Verification of member eligibility and benefits
  • PCP membership reports
  • Submission and review of authorization requests
  • Claim status checks
  • Reconsideration submissions
  • Payment remittance advice
  • C3 (Clear Claims Connection) access
Our Provider Network education and support offers:
Field Network Educators
A direct resource for education, assistance, trouble shooting, and individualized one-on-one support.
Provider Relations Contact Center
Access to a team of Provider Relations representatives to address claims, authorizations, and member eligibility questions/concerns.

Participate

Participate with Optima Family Care of North Carolina!

By signing a non-binding Letter of Interest (LOI) with Optima Family Care of North Carolina, you are expressing interest in participating as a provider of healthcare services with Optima Family Care of North Carolina.

Click here to download the LOI

Contract requirements and rates will be provided at a later date when NCDHHS releases this information.

Signing does not obligate the provider to contract with Optima Family Care of North Carolina.

Join Optima Family Care of North Carolina today!
Call (252) 384-2828 or Click here to Contact Us

Contact Us

Call (252) 384-2828 or submit the form below and an Optima Health representative will contact you.

(PO Boxes should not be used for physical practice location.)
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