NC Department of Insurance
Managed Care & Health Benefits Division
PO Box 26387
Raleigh, NC 27611
Attn. Provider Complaints

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You may reach the Managed Care & Health Benefits Division by calling 919-715-0526, but a written complaint will be required before a complaint can be pursued with an insurer. The complaint form can be obtained at: Provider Complaint Form.

The NCAFP is also interested in collecting copies of any complaints that may be filed with the Department of Insurance. Please fax a copy of the complaint to the NCAFP at 919-833-1801

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What can I do if one of my patients has a complaint about a managed care company? - Refer the patient or family to the NC Department of Insurance's Consumer Services at: 1-800-546-5664. The Goal of the Consumer Services Division is to respond promptly, clearly, and courteously to questions and complaints from the public concerning insurance and to acquaint consumers with alternatives and courses of action which a citizen can pursue to solve a particular insurance problem. They can discuss their problem or they can file a complaint online. See the Consumer Complaint Form.

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What managed care contracting assistance is available for my practice? - NC Department of Insurance Managed Care & Health Benefits Division has developed a contract compliance checklist to aid in the review of specific managed care agreements. It can be obtained at: NC DOI Website. Contact the NCAFP at ncafp@ncafp.com or 919-833-2110.

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What is the status of Prompt Pay legislation in North Carolina? - A Prompt Pay Law became effective on July 1, 2001. An insurer shall, within 30 calendar days after receipt of a claim, send by electronic or paper mail to the claimant:

1. Payment of the claim.
2. Notice of denial of claim.
3. Notice that the proof of loss is inadequate or incomplete.
4. Notice that the claim is not submitted on the form required by the health benefit plan, by the contract between the insurer and healthcare provider or healthcare facility, or by applicable law.
5. Notice that coordination of benefits information is needed in order to pay the claim.
6. Notice that the claim is pending based on nonpayment of fees or premiums.

A copy of the "Prompt Pay Law" can be obtained at the NC Department of Insurance: Prompt Pay Law.  Information on what to do if you are not receiving prompt payment or appropriate communication from a health plan can be obtained from: Prompt Pay Guidance.

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Legislative Issues-

How can I contact my legislator? - If you don't know who your Representative or Senator are, go to this website: Who Represents Me?

For links to House of Representatives member websites:
House Member Websites

For links to Senate member websites:
Senate Member Websites

I want to track a bill currently under consideration; how can I do that? - To search for a bill, go to this website: Legislative Bill Search.

I want to read the exact text of a N.C. General Statute; where can I find this? - To read parts of the N.C.G.S, go to this website: NC General Statutes

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Practice Management-

What are the new guidelines concerning pharmaceutical company relations with medical practices? - The Pharmaceutical Research and Manufacturers of America (PhRMA) adopted, effective July 1, 2002, the following voluntary Code on relationships with healthcare professionals. This Code addresses interactions with respect to marketed products and related pre-launch activities. It does not address relationships with clinical investigators relating to pre-approval studies.

View a copy of the Code here: PhRMA Guidelines

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I have some general practice management questions or issues. What resources are available to me? - The NCAFP is happy to work with you to clearly identify your issues, locate appropriate resources, or make referrals to experienced individual consultants or companies. Contact the NCAFP at ncafp@ncafp.com or 919-833-2110.

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I have some questions about the management and disposal of medical waste. How can I find information on this topic? - The NC Medical Waste Management Regulations are administered by the North Carolina Department of Environment and Natural Resources, Division of Waste Management. You can go to their website, obtain information, and email any specific questions to the appropriate staff for your geographic area. Refer to: NC Division of Waste Management

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How can I obtain information relating to salaries for family physicians and other health care providers? - Several organizations publish information relating to salaries for family physicians, other specialties, and other health care providers and workers. Some of the more useful websites include:

Median & Mean Income for FP's    http://www.aafp.org/x866.xml
Facts About Family Practice    http://www.aafp.org/x530.xml
US Bureau of Labor Statistics    http://www.bls.gov/oes/home.htm

Also, it may be helpful to use a search engine, such as www.Google.com, and search using the term "salary" and then the type of specialty or health care provider, e.g. "Salary Nurse Practitioner".

The Academy's Professional Services is also more than happy to assist members in locating relevant and timely data on salaries and other related questions.

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What medical malpractice companies currently operate in North Carolina? - Unfortunately, this "line-up" changes from time-to-time. NCAFP will attempt to keep this list as up-to-date as possible:

Medical Mutual Insurance Company of North Carolina
700 Spring Forest Road
P.O. Box 98028
Raleigh, NC 27624
(800) 662-7917
Fax - 919-878-7550
Steve Parker
steve.parker@mmicnc.com

GE Medical Protective
2000 Regency Parkway
Cary, NC
(919) 467-8370
Suite 295
Cary, NC 27511-8520
919-467-8370
800-633-2285
Fax - 919-380-1775
Sharon Musselman - NC Manager
Sharon.Musselman@gemedicalprotective.com


MAG Mutual Insurance Company of Georgia
Eight Piedmont Center, Suite 600
3525 Piedmont Road
Atlanta, GA 30305
(404) 842-5600
800-282-4882
Michael Tekely - NC Sales Manager
336-227-5580
Fax - 336-263-2181
mtekely@magmutual.com


The Doctors Company
http://www.thedoctors.com/
185 Greenwood Rd.
Napa, California 94558
800-421-2368 Todd Burkess - Contact in California
800-372-3268 Ottis Wagner - Contact in NC (Charlotte)


Brokers - Represent Several Different Companies
Ottis Wagner
Professional Liability Solutions
(Represents The Doctors Company & GE Medical Protective)
800-372-3268

Membership / Continuing Medical Education

I paid my dues, but I've been dropped from membership. Why? - More than likely, you have not met a requirement of your membership classification. If you are an active or family practice supporting member, you must submit 150 hours of continuing medical education every three years (reelection).

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I am an American Board of Family Practice diplomate; can you accept hours submitted to the Board? - If those hours have been submitted in the 3 years prior to application to AAFP membership, we will accept them upon receipt.

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Can I report hours for taking and passing the Board recertification exam? - No, this is considered a professional responsibility rather than continuing medical education. However, any programs that you attended that helped you to prepare for the recertification exam are acceptable.

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Who notifies the AAFP about my CME hours? - You are responsible for reporting your hours to the AAFP. You may report them via the AAFP website at www.aafp.org; or you may fax the hours on a CME reporting form to the AAFP at (913) 906-6092; or mail them to AAFP 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2472.

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I reported my hours to the AAFP, but they are not reflected on my CME Report. What's happening? - It takes the AAFP at least one business day to enter your information into the database. Check the website at a later date; your hours should be reflected.

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I've reported over 150 hours of CME to the AAFP, but I'm still not eligible for reelection. Why? - The following three reasons may be the cause:

1. You may not have reported the minimum required 75 Prescribed hours.
2. You may not have reported the minimum requirement of 25 hours of group learning activities.
3. You may have exceeded the maximum limits of enrichment hours (no more than 25 during a three year period); publication of an original research paper (no more than 45 during a three year period); presentation/publication of a paper (no more than 30 during a three year period); or preparation/presentation of a scientific medical exhibit(no more than 15 during a three year period).

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I'm up for my re-certification, can you tell me where the boards are being held? - The American Board of Family Practice prefers to handle all questions regarding their organization. You can contact them via their website: www.abfp.org or American Board of Family Practice, Inc. 2228 Young Drive Lexington, Kentucky 40505-4294 Phone: 859-269-5626/888-995-5700 FAX: 859-335-7501 or 859-335-7509 E-mail: general@abfp.org

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I want to join the North Carolina Academy of Family Physicians (NCAFP); do I have to be an American Academy of Family Physicians (AAFP) member too? - Yes, the NCAFP is a constituent chapter of the AAFP. Therefore, we follow the AAFP bylaws which state that you must be a member of both the national and the constituent chapter.<

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I've been an active member for 15 years and am 60 years old; I plan to retire next year. Am I eligible for Life membership? - No. In order to become a Life member, you are required to have 1). 20 years of continuous membership and be completely retired from practice; and/ or 2). 20 years of continuous membership and age 70 or over.

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Is there a category for Active physicians who have decided to return to school for further education such as pursuing an MBA, JD or additional residency or fellowship? - Yes, membership guidelines allow you to become an inactive member while pursuing your degrees. Upon a change in your status, your dues will be reduced, you will no longer be required to maintain continuing medical education, and you may have the floor at Assembly but may not vote or hold office. Your inactive status will be reviewed annually.

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I've been an Inactive member for a couple of years and would like to become active again, what do I need to do? - You will need to request a change in status and provide proof of 150 hours of CME for the 3 years proceeding application.

Data/Studies-

Do you have any salary data available for Physician Assistants? - Yes, the NCAFP has salary data available for a variety of positions. For further information on specific job categories or positions, please contact the NCAFP at (919) 833-2110.