Provider Supplemental Information FAQs

NCTracks is collecting this additional information to assist in streamlining the data collection process for providers and Prepaid Health Plans (PHPs) to facilitate network eligibility determinations.

No, only individual providers (excluding OOS Lite, Disaster Relief, and Medicare Lite providers) will be required to supply this additional information.

Currently enrolled providers are not required to supply this information until a re-enrollment or re-verification application is submitted.

The information provided on the Provider Supplemental Information page may not be updated by completing an MCR. If the information provided on this page is inaccurate, the provider must correct it the next time they complete a re-verification application, or if they are terminated, when they re-enroll.

No.

• Only list the last 5 years of work history.
• Only list healthcare related work history.

Providers should list their current employment in this history with the applicable start date and an end date of 12/31/9999 (regardless of anticipated end date).  Individual application types require at least one employment entry with this end date.

Enter all applicable work history.

 

If you work history begins more than 6 months after your license effective date, you will be required to submit a letter of explanation of the gap.  The provider must write, sign, and date an explanation of any gap of six months or more in their work history. This explanation document must be uploaded to the ‘Upload Documents’ page in the application. A faxed, digital, electronic, scanned, or photocopied signature on the letter of explanation is acceptable. However, signature stamps are NOT permitted.

 

If you work history begins within 6 months after your license effective date, and there is no additional gap of six months or more, then no additional information will be required.

Yes, enter fellowship as work history.

If the enrolling provider is currently a resident or intern, when adding work history,  enter the details of that residency/internship, such as:

                 Job Title: Resident

                 Company Name: Healthcare Facility XYZ

                 Start Date:  Date residency/internship began

                 End Date: 12/31/9999

If the employer is the same for all locations of employment, only one entry for that employer is required with the date initially started.

You should list the locum tenen’s employer name and date of hire.

Enter residency information in the education section.

In addition to entering required certifications, individual providers are now encouraged to add all board certifications.

 

If the provider is board certified, this is treated as the highest level of education and should be listed as such.  The Accreditation Page may not state that a board certification is required.  However, if reporting board certification as the highest leve of education, providers should enter their certification information on the application. This can speed up application processing.

If a provider designated as a prescriber on the Provider Permission Matrix (PPM)* but does not have a DEA certification, the provider must:

1. Enter 123456789 as the DEA certification number.

2. Complete the DEA Designation Form (found on the Provider Policies, Manuals, Guidelines and Forms page under Provider Forms) indicating the reason for not having a DEA certification, selecting one of the following reasons on the form:

• The prescribing provider is currently working on obtaining their DEA license (it is in process or is still pending). They must elect a temporary alternate prescriber to write prescriptions for controlled substances on their behalf until they have a valid certification. The form must be completed providing the alternate prescriber’s information.
• The prescribing provider elects not to prescribe controlled substances themselves but prescribing controlled substances is in their scope of practice. They must identify another doctor to write these prescriptions on their behalf. The form must be completed providing the alternate prescriber’s information.
• The prescribing provider does not prescribe or refer prescriptions for controlled substances because they believe their patients do not require controlled substances. In this circumstance, the provider must sign the statement on the form indicating this and describe their process for handling instances when a patient requires a controlled substance….
• The prescribing provider is in an ACGME accredited training program and does not practice independently. Note: This information must be updated once the program is complete.

3. Upload this form to the Upload Documents page under Status Management when submitting an application.

See DEA FAQs.

 

• If the provider is board certified by one of the Applicable Board Certifications below, this is treated as the highest level of education. A transcript will not be required.  The Accreditation Page may not state that a board certification is required.  However, please put this on the application if intending to use the board certification in place of a school transcript.
• If the provider is licensed by one of the licensure Boards listed, the board source-verifies your education; a transcript will not be required.
• If the provider’s AMA Physician or Physician Assistant Profile lists the highest level of education completed, a transcript will not be required.
• For all other providers, a transcript will be required.

 

Applicable Board Certifications:

• The American Board of Allergy and Immunology
• The American Board of Anesthesiology
• The American Board of Colon and Rectal Surgery
• The American Board of Emergency Medicine
• The American Board of Family Medicine
• The American Board of Internal Medicine
• The American Board of Neurological Surgery
• The American Board of Obstetrics and Gynecology
• The American Board of Ophthalmology
• The American Board of Orthopaedic Surgery
• The American Board of Otolaryngology – Head and Neck Surgery
• The American Board of Pediatrics
• The American Board of Physical Medicine and Rehabilitation
• The American Board of Plastic Surgery
• The American Board of Preventive Medicine
• The American Board of Psychiatry and Neurology
• The American Board of Radiology
• The American Board of Surgery
• The American Board of Urology
• American Board for Certification in Orthotics; Prosthetics & Pedorthics (ABC)
• National Commission on Certification of Physician Assistants (NCCPA)
• The American Board of Dermatology
• The American Board of Medical Genetics and Genomics
• The American Board of Nuclear Medicine
• The American Board of Pathology
• The American Board of Thoracic Surgery, and Urology boards

   

No. Only list your highest level of education.

Enter the residency as your highest level of education with the residence completion date.

No. Providers should not upload their school transcripts or residency verification letters. If a school transcript is requested, providers should contact their school/residency program and request them to mail or email the official transcript/residency verification to NCTracks at ProvEnrollSuppData@gdit.com. The email address will also be provided in the returned application letter.

 

If the school is unable to electronically send the transcript/residency verification to the secure email address, request the school send a sealed copy to the following address:

Provider Enrollment

PO Box 300009

Raleigh, NC 27622

Due to the potential delay depending on medical or professional schools returning the transcripts/residency program verification, an adjusted time frame will be offered for applications in this circumstance. Providers will initially have 30 days to submit the transcript/residency verification. If NCTracks does not receive it within 30 days, another 30-day notice will be sent requesting the transcript/residency verification, prompting the provider to follow up. This will allow a total of 60 days for receipt of the documentation. If the transcript/residency verification has not been received within 60 days, the application will be abandoned, and the provider must resubmit the application and pay all applicable fees.

Email a copy of the current documentation you have (Ex: Copy of Degree) along with explanation of why the official transcript cannot be retrieve to ProvEnrollSuppData@gdit.com.

When the provider requests the school transcript, ask the school to copy the provider when submitted via email.  This allows the provider to forward that email to ProvEnrollSuppData@gdit.com to confirm that the transcript was submitted.

If the school is unable to electronically send the transcript/residency verification to the secure email address, request the school send a sealed copy to the following address:

Provider Enrollment

PO Box 300009

Raleigh, NC 27622

Contact the school and ask that the Residency Completion Letter be sent directly from the Residency program school to ProvEnrollSuppData@gdit.com.

NCTracks accepts a variety of residency verification; it may be a residency transcript, verification letter or residency certification.

No, the malpractice insurance certificate is not required at time of application.  Providers will be asked to supply Malpractice Type, Insurance Agency Name, Amount, Effective Date and Expiration Date. If additional information is needed, it will be requested.

Malpractice insurance information may only be updated or reported at time of enrollment, re-verification, or re-enrollment application. Providers are not required to report changes to their insurance at any other time unless it is requested. Providers are encouraged to make sure their information is properly submitted to NCTracks.