Carolina Care Plan redefining who is a specialist

 From Carolina Care/Medical Mutual:

We are redefining what types of providers are considered primary care providers (PCP) and specialists as communicated in the October 10 Broker Update.

 To be compliant with Federal Mental Health Parity requirements, mental health claims for the 51+ groups with a different copay for PCPs and specialists will be reviewed. The providers listed below were redefined as PCPs beginning with plan years on or after July 2010:

  1. Psychiatry
  2. Geriatric Psychiatry
  3. Child and Adolescent Psychiatry
  4. Addiction Psychiatry
  5. Psychology
  6. Licensed Independent Social Worker
  7. Licensed Professional Clinical Counselor
  8. Licensed Marriage-Family Therapist

Members who had claims for these types of providers after their group’s plan year will have their claims adjusted. The specialist copay that was originally taken for these providers will be adjusted to the PCP copay.

Please note: This change does not impact groups and members in the 2-50 market.


To help members understand the changes to the PCP and specialist definitions, we will send letters to all impacted group officials and members.

Members who are impacted by the se changes will receive a follow-up letter notifying them that they have a credit or may be eligible for reimbursement from their providers. Due to the volume of claims to review, these letters will be sent over the next several months and will start with groups that have plans years effective July 2010.