Provider Re-credentialing/Re-verification

What is this about?

The Affordable Care Act mandates that all Medicaid Providers must be revalidated every 5 years. This is to ensure that provider information is accurate and current. As part of this process, the provider’s credentials and qualifications will be evaluated to ensure they meet the professional requirements and are in good standing. The re-credentialing process also includes a criminal background check on all owners and managing relationships associated with the provider record.

Is it Re-credentialing or Re-verification?

The terms re-credentialing and re-verification are used interchangeably in NCTracks. Either is acceptable.

How will I know if I need to complete the Re-credentialing application?

You will receive a re-credentialing/re-verification invitation via the NCTracks secure portal when you are scheduled to begin the re-credentialing process.

Note: Providers cannot access the re-credentialing application until they receive an invitation to begin the process.

Is there a fee required?

In accordance with North Carolina Senate Bill 105 Session Law 2021-180 Section 9D.9(d), the waiver to the NC Medicaid provider enrollment and revalidation/reverification application fee expired on June 30, 2023. 

Beginning July 1, 2023, providers submitting enrollment or revalidation/reverification applications will be assessed the $100 NC Medicaid Provider Application Fee. This is in addition to the Federal Fee imposed for specified taxonomies. 

When applicable, providers may be required to pay a federal fee. Fees by year may be found in the spreadsheet State and Federal Fee Amounts by Year located under Quick Links on the Provider Enrollment page. Fees must be paid when submitting the re-verification application. Refer to the Provider Permission Matrix on the NCTracks Provider Enrollment page to determine if the federal fee is required. For more information refer to the Federal Fee and NC Application Fee FAQ page.

How Much Time do I have to complete the Re-credentialing process?

A provider is given 70 days from the initial notification date to complete the re-verification. Providers who act promptly upon receiving the notice have ample time to resubmit if their application is denied (unless as indicated below), withdrawn, or abandoned.

Do not wait to submit. Take advantage of the 70-day timeframe given to ensure completion without adverse action.

The Reverification must be completed, and applicable fees paid, by or before 5pm on the due date; otherwise, the provider record will be suspended, and claims will pend. The provider will receive a suspension letter via regular mail to the correspondence address on record as well as via the NCTracks message center.

Providers must understand the risk of delaying submission.

Corrections cannot be made to any application once submitted, so any errors or omissions in a reverification application can result in the application being abandoned, denied or withdrawn. Providers who have responded promptly to the reverification notice will have ample time to re-submit. Providers are advised against waiting until a suspension has been placed on the record to submit the reverification, because at the point of suspension, the reverification due date has passed.  Any submission beyond that date is delinquent and places the provider at risk of termination. After the suspension date, if a reverification application contains errors or omissions that result in the application being abandoned, denied or withdrawn, the provider’s NCTracks enrollment record automatically terminates. Re-enrollment is required to continue participation in DHHS programs.

What happens if I don’t complete the Re-credentialing application?

Your enrollment with all NC Department of Health and Human Service (NC DHHS) health plans will be terminated, and you will be required to submit a re-enrollment application if you wish to continue to render services for any NC DHHS plan, including NC Medicaid, Department of Public Health, Office of Rural Health, or Division of Mental Health/Developmental Disabilities/Substance Use services.

What happens if my re-verification application is denied?

If your re-verification is denied due to a negative background finding, failure to complete fingerprinting, bad data, or expired credentials (license/accreditation/certification per the Provider Permission Matrix), all NC DHHS health plans will be terminated.