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Community Care Plan

Community Care Plan (CCP), the health plan with a heart, is the first and longest standing provider service network (PSN) in Florida. We are owned by South Florida’s most experienced names in healthcare: Broward Health (North Broward Hospital District) and
Memorial Healthcare System (South Broward Hospital District) in Broward County.  

CCP is a member of Florida Association of Health Plans (FAHP) and the Association of Community-Affiliated Plans (ACAP). The National Committee for Quality Assurance (NCQA) has awarded South Florida Community Care Plan Network (dba Community Care Plan) an accreditation status of Accredited for service and clinical quality that meets NCQA’s rigorous requirements for consumer protection and quality improvement. Community Care Plan has also earned Health Equity Accreditation for its Medicaid Health Plan from the National Committee for Quality Assurance (NCQA).

Community Care Plan is also accredited by the Accreditation Association for Ambulatory Healthcare as a Health Plan.

Our Health Plans

  • Medicaid and SMI

For Medicaid, CCP was awarded Managed Medical Assistance (MMA) Plus, including the serious mental illness populations for five regions (E, F, G, H, and I). 

This includes the counties:

  • Brevard
  • Broward
  • Charlotte
  • Collier
  • Desoto
  • Glades
  • Hendry
  • Indian River
  • Lee
  • Martin
  • Miami-Dade
  • Monroe
  • Okeechobee
  • Orange
  • Osceola
  • Palm Beach
  • Sarasota
  • Seminole
  • St. Lucie

Florida Healthy Kids

CCP is currently a health plan choice for Florida Healthy Kids, a Florida KidCare program, in eight counties:

  • Broward
  • Indian River
  • Martin
  • Miami-Dade
  • Monroe
  • Okeechobee
  • Palm Beach
  • Saint Lucie

Employer health plans and uninsured

CCP serves as the Third-Party Administrator (TPA) for employer health plan and the uninsured. These include:

  • Memorial Healthcare System employees
  • Community Care Plan employees
  • Health Care District of Palm Beach County (HDCPBC)
    • We administer HDCPBC’s District Cares Program’s contracting, credentialing, and Provider services.
    • We currently provide claim and authorization services to our District Cares Providers, and integrate the credentialing, contracting, and Provider services for the program to streamline the process and offer enhanced customer service to Providers.
  • Broward Health
    • We administer the health benefits for Broward Health’s Physician Payment for Uncompensated Care (PPUC) program.

Together, we collaborate with providers, leveraging our individual expertise to uphold the high standards expected by our community.

Our Provider Operations Department partners closely with providers to ensure that CCP members receive high-quality health care and services. CCP offers comprehensive support to providers and their offices for various procedures required by CCP, including but not limited to:

Provider Orientation

A comprehensive introduction to CCP’s processes, policies, and systems, designed to ensure providers have the necessary tools and resources to succeed from the start.

Educational Overviews on Compliance Issues

Regular updates and training on compliance topics, including billing practices, documentation standards, and regulatory changes to mitigate risk.

On-Site Support at the Provider’s Office

Personalized support, including hands-on assistance and staff training.

Processing Practice Changes and Updates

Support with updating practice information, including changes in provider status, location updates, and panel management.

Verifying Eligibility, Reviewing Claims Status, and Requesting Pre-authorizations

Assistance with verifying patient eligibility, navigating the claims process, and obtaining necessary pre-authorizations to ensure smooth service delivery.

Addressing Questions on Procedures, Policies, Reimbursement, and Other Program Information

A dedicated team is available to answer any questions related to CCP’s policies and procedures, reimbursement structures, and program details.

Provider Portal Assistance

Support with accessing and using Planlink, the CCP Provider Portal. This includes setting up accounts, navigating the portal, and troubleshooting issues. The portal allows providers to verify patient eligibility, submit and track claims, submit prior authorizations, and review important updates and resources.

Our Provider Operations Representatives conduct regular visits to CCP provider sites. During these visits, they assess the practice’s overall compliance with various regulatory and program standards, including:

Access to Care

Ensuring members have timely access to health services, including urgent, preventive, and specialty care.

Physical Accessibility of the Practice Environment

Evaluation of the facility’s accessibility, including accommodations for individuals with disabilities.

Medical Record Keeping Practices

Assessment of the completeness, accuracy, and security of medical records in accordance with legal requirements.

OSHA Compliance

Ensuring adherence to Occupational Safety and Health Administration (OSHA) standards for a safe and healthy workplace.

Patient Confidentiality Procedures

Verification that patient information is handled in compliance with HIPAA and other privacy regulations.

Facility Appearance and Adequacy

Ensuring the practice environment is clean, safe, and conducive to providing high-quality care.

Additional Resources and Support

Manual & QRGs

Provider Alerts

Important Contacts

Forms

Provider Academy

Compliance

Preventitive & Practice Guidelines

Provider Portal Access

CCP Provider Operations Representatives are available to assist with any of the services outlined above from 8 AM to 7 PM, Monday through Friday. For support, please contact the CCP Provider Operations Hotline at 1-855-819-9506.

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