Behavioral Health Provider Enrollment FAQs

Centers for Medicare & Medicaid (CMS) has issued final regulations that revise and significantly strengthen existing Medicaid managed care rules. As a result of 42 CFR 438.608 (b), the State, through its contracts with a MCO, PIHP, PAHP, PCCM, or PCCM entity, must ensure that all network providers are enrolled with the State as Medicaid providers, consistent with the disclosure, screening and enrollment requirements of CFR 455, subparts B and E.

The Office Administrator (OA) is the primary point of contact for the NCTracks record, with the authority to modify the record and assign security roles for your provider entity. State Policy requires the OA to be an owner or some other individual who has managing authority for the provider or provider entity. An OA will use their NCID (North Carolina Management Identifier) to access the Provider Portal. The portal allows providers to access eligibility information, inquire about claim status, submit claims and obtain their Remittance Advice (RAs).

Providers submitting enrollment or revalidation/reverification applications will be assessed the $100 North Carolina Provider Application Fee. This is in addition to the Federal Fee imposed on specified taxonomies.

Please refer to the Provider Permission Matrix to determine if the taxonomy you are enrolling with requires payment of the Federal Application Fee. For more information, please visit the Federal Fee and NC Application Fee FAQs.

In accordance with Title 42 CFR 455.434 and 42 CFR 455.450 (c), fingerprint-based background checks are required for all high categorical risk providers and their owners who have a 5% or greater direct or indirect ownership interest as a condition of enrollment in NC Medicaid. The Provider Permission Matrix identifies which taxonomies require fingerprinting. For more information, see the Fingerprinting FAQs.

No, per NCGS 108C-9 Providers are only required to complete training prior to being initially enrolled.

Re-verification is sometimes referred to as re-credentialing or re-validation. These words are used interchangeably. This process is required every five years. As part of this process, the provider’s credentials and qualifications will be evaluated to ensure they continue to meet the professional requirements and are in good standing. The re-verification process also includes a criminal background check on all owners and managing relationships associated with the provider record. A re-verification application will appear in the secure provider portal when it is time to re-verify. Until then, the Re-verification section will read No Data to Display.

 

Ongoing verification only occurs when a provider license or certification is due to expire. When credentials required for NC Medicaid participation are expiring, NCTracks sends a 60-, 45-,14-,7-, and 2-day notification informing the provider of the need to ensure an update is made to their required credential.  The update must be made prior to the expiration date on the NCTracks record to avoid suspension and subsequent termination of the taxonomy. A credential update is completed using the Manage Change Request (MCR) application to update the license number or expiration date.

 

A provider will be required to complete a Maintain Eligibility application if no claims containing their NPI are submitted within a twelve-month period. This process is used to verify that the provider still intends to remain active. When a provider has not billed claims within twelve months, the provider will receive a notification in the NCTracks Provider Message Inbox asking the provider to complete the Maintain Eligibility application. If the provider does not complete the Maintain Eligibility application by the due date, the provider record will be terminated. If the provider record is terminated, a re-enrollment application will be needed to continue to participate in the North Carolina Medicaid program.

A “How to Add or Update Accreditation on the Provider Profile in NCTracks” User Guide is posted that provides step-by-step instructions for adding or updating a license, certification, or accreditation on a provider record.  It can be found on the Provider User Guides & Fact Sheets page of the NCTracks Provider Portal under the heading "Provider Record Maintenance."

 

It takes approximately 10 business days to process the MCR. Providers must be sure to submit the MCR to update their credential in time for processing to be completed prior to expiration. If there is a pending MCR when the notification is received that did not include updated credential information, the provider has the option and is encouraged to withdraw the pending MCR and resubmit with the license/accreditation/certification renewal information to ensure the update is processed prior to suspension/termination date.

 

If the taxonomy is suspended, submission of an MCR will not lift the suspension. The MCR must completely process before the suspension would be lifted the following day.

No. Adding a taxonomy code requires verification that provider credentials meet the requirements outlined for the taxonomy on the Provider Permission Matrix (PPM). When adding a new taxonomy, be mindful of the chosen effective date, which can be up to 365 retroactive, but cannot precede the effective date of the required credential.  If no effective date is chosen, the system will default to an effective date matching the date of application submission.

Yes. Behavioral Health providers who previously requested initial enrollment through an LME/MCO are required to enroll via NCTracks. The LME/MCOs no longer perform credentialing.

All health plans receive the provider data that’s necessary for provider contracting via the Provider Enrollment File. For more information on provider contracting, please visit Provider Contracting with Health Plans | NC Medicaid.

The agency name and NPI# should be entered in NCTracks, not the unlicensed AFLs and Therapeutic Foster Care homes.