Administrative Care Coordination (ACC) and the Nurse Ombudsman at Talbot County Health Department
What is ACC?
The primary purpose of the ACC and Ombudsman Program is to assist HealthChoice eligible Medicaid and MCHP beneficiaries in accessing and appropriately using their health care benefits.
Information typically covered when providing ACC-Ombudsman assistance to HealthChoice enrollees:
- Case specific information; for example specific protocols for pregnant women;
- Fee-for-service system and how to use prior to MCO enrollment;
- Importance of selecting and using a primary care provider;
- Renewing or updating Medicaid MCHP coverage;
- Select an MCO and how the managed care system works;
- The importance of timely follow-up, especially when appointments or treatments have been missed;
- Benefits and the importance of preventive health care, dental care, lead screening, and immunizations for children;
- Availability and importance of preventive services such as pap smears, mammograms, etc;
- Self-referred services such as the ability to maintain your established prenatal care provider, ability to access out-of-network family planning services and substance use/behavioral health services;
- “Carve-out” services, such as mental health and dental services for children and pregnant women;
- Family planning and preconception health services;
- Transportation and the M.A. Transportation program
- MCOs for disease management, care coordination or case management services;
- The HealthChoice Help Line, and local ACC/Ombudsman serv
- A li
- st of local HealthChoice providers and resources.
The ACC-Ombudsman program offers support to local providers. Our staff is knowledgeable about the changes in health care systems and financing to the extent that they can answer basic
questions and refer providers to additional resources when needed.
We are able to:
- Link potential Medicaid providers to Provider Enrollment for assistance with the enrollment process; Provide education about MA web-based resources and Eligibility Verification Systems;
- Provide contact numbers for central office program staff who can answer provider questions and resolve problems;
- Provide updates on changes to Medicaid operations, such as changes to CMS 1500 claim form and ICD 10;
- Provide information on CRISP to assure more accurate and timely information for PCP selection;
- Inform providers about the Local Health Services Request referral process;
- Promote completion of the Maryland Prenatal Risk Assessment and referral process by prenatal care providers; and
- Convey new and emerging topics of importance to the Medicaid Program to providers and stakeholders.
Phone: 410-819-5600 ext. 5654, or ext. 5684
En Espanol: 410-819-5605
Monday through Friday
8:00 a.m. to 5 p.m.