North Carolina Department of Health and Human Services (NCDHHS) Credentialing Committee FAQs

The Credentialing Committee will review NCDHHS provider applications that contain adverse action items prior to final disposition of their enrollment, reenrollment and recredentialing applications as well as items discovered through ongoing monitoring.

The Credentialing Committee is scheduled to begin activities in October 2025. The committee will meet weekly to review adverse action items in depth and to ratify clean applications.

The Credentialing Committee is made up of voting and non-voting members. The voting members include:

• One Medical Director (employed by General Dynamics Information Technology (GDIT))
• Two NC Medicaid representatives
• One representative from each health plan
• Multi-payers (Division of Mental Health, Developmental Disabilities and Substance Use Services, Division of Public Health and Office of Rural Health) representatives

Non-voting members may include the Credentialing Coordinator, Peer Expert Specialists and Peer Expert Non-Physician Practitioners, as needed.

 

More information on how to apply to become a Peer Reviewer will be shared soon.

Yes, they are volunteer roles.

The Committee reviews application files for all provider types, including individuals and organizations. Files with no findings are categorized as clean and ratified weekly. Files with adverse action items are reviewed in detail by the Committee.

A clean file has no adverse action findings. These are formally approved by the Credentialing Committee Medical Director and ratified during the Committee meeting. Clean files are not reviewed individually.

Credentialing and recredentialing standards are not changing and are based on current National Committee for Quality Assurance (NCQA) Federal and State guidelines. The official bylaws of the Credentialing Committee are available for reference on the Credentialing Committee website under Additional Resources.

Current processing times for clean applications can be found on the NC Medicaid Provider Enrollment web page. The Department does not anticipate a significant change

GDIT is building a secure portal for file distribution and training. Details forthcoming in stakeholder sessions.

Providers will have full appeals rights for adverse decisions, just as they do today.

No. NC Medicaid currently operates under a waiver allowing five-year re-verification cycles.

The current Fiscal Agent continues primary-source verification; NCDHHS and NC Medicaid  Credentialing Committee provides oversight.

No changes will be made to current provider enrollment files.

NC Medicaid and the Prepaid Health Plans are currently operating under NCQA waivers and will continue to do so when the Credentialing Committee is implemented. At some point, the waivers may be revisited.

Yes, the committee includes a diverse representation of provider specialties. While the core voting members include representatives from NC Medicaid, managed care plans, and other state divisions, the non-voting participants may include peer reviewers.

Please refer to the NCQA website for more information regarding NCQA requirements for health plans. Current requirements implemented by NC Medicaid for provider enrollment will continue to be subject to NCQA, Federal and State guidelines.

 

 

More information can be found on the NC Medicaid Credentialing Committee Questions and Answers webpage.

 

For specific questions related to the Credentialing Committee, please email medicaid.credcommittee.stakeholders@dhhs.nc.gov.