License and Accreditation FAQs

A new User Guide has been posted that provides step-by-step instructions for adding or updating accreditations on a provider record.  It can be found on the Provider User Guides and Training page of the NCTracks Provider Portal under the heading "Provider Record Maintenance."

NCTracks receives a data file weekly from the following boards:

• Drug Enforcement Agency (DEA)
• Clinical Laboratory Improvement Amendments (CLIA)
• North Carolina Medical Board
• North Carolina Dental Board
• North Carolina Board of Nursing
• North Carolina Division of Health Service Regulation (DHSR)
• North Carolina Board of Optometry.

NCTracks receives a file monthly from the North Carolina Board of Pharmacy.

 

When the file is received, NCTracks automatically updates the expiration dates in the provider record, so you may not need to submit an update in NCTracks if the credential is current with the board.

 

However, if you receive a letter that you need to update your credential, make sure it is updated with the board and that your NCTracks provider record has the correct credential number on file.

 

NOTE: There can be a time gap between the credential update with the board and NCTracks receiving the data to update the expiration date on the provider record . Ultimately, providers are responsible to ensure their required credentials remain active. For this reason, providers retain the ability to update the expiration date with a Manage Change Request. The credential will still be validated, but this can prevent suspension or termination due to expired credentials.

NCTracks sends notifications for expiring credentials (licenses, certifications, and accreditations) to all enrolled providers required to be licensed, certified and/or accredited. These notices are sent to the Provider Message Center Inbox in advance of the expiration date of the credential.  

The first letter will be sent to the NCTracks Provider Message Center Inbox 60 calendar days prior to the expiration of the credential with the subject Provider Re-certification Letter. If the credential is not updated, a reminder notification is sent at 30 calendar days and again at 14 calendar days prior to the expiration of the credential. The final reminder is sent seven calendar days prior to expiration date.

The taxonomy code(s) that required the credential will be suspended if it has not been updated by the expiration date. A suspension letter will be generated and sent to the NCTracks Provider Message Center Inbox with the subject Recertify Suspension Letter. The suspension will remain in place for 60 calendar days. If the expiration date is validated as renewed through an automated data file or processing of a Manage Change Request, the suspension will be lifted.

 

Note: Suspension means your claims will pend and will not adjudicate until the suspension is lifted.

If your credential is one of the types for which we receive a file from the board, the suspension will be removed upon receipt of an update from the board.

 

Otherwise, submit an MCR updating your credential. Once the application has been approved, the suspension will be removed.

The provider's taxonomy code(s) that requires the expired credential will be terminated on the 61st calendar day following suspension. If the terminated taxonomy represents the only taxonomy for that location or provider record, then the service location or enrollment record will also terminate. If you are terminated, you must reapply to participate in North Carolina Medicaid and receive payment through NCTracks or our other vendors

Refer to the User Guide “How to Add or Update Licensing and Accreditation on the Provider Profile in NCTracks” under the heading Provider Record Maintenance on the Provider User Guides and Training page of the NCTracks provider portal. NOTE: Providers must be sure to submit the MCR to update their credential in time for processing to complete prior to expiration.

 

If there is a pending MCR when the notification is received that did not include updated credential information, the provider may withdraw the pending MCR and resubmit with the license/accreditation/certification renewal information to ensure the update is processed prior to suspension/termination date.

Specific qualifications for each provider type are listed in the Provider Permission Matrix (PPM). The PPM and instructions for how to use it are posted under Quick Links on the Provider Enrollment page of the NCTracks provider portal.

The license number should be keyed with dashes exactly as it appears with your license authority.

NCTracks receives some provider license information directly from the licensing authority, such as the Medical Board. When you key your medical license into NCTracks, it will be validated against the information received from the Medical Board or other licensing authority. However, if you have only recently obtained your license, NCTracks may not have received the information yet. If you receive an error message regarding your license, try again at a later date.

Do not submit a MCR to update your licensure data. Instead submit a re-verification application. You can update the licensure data in the re-verification application.