Provider Enrollment and Credentialing FAQs

No. The provider’s full legal name should be entered on the application. If the full legal name is not on the application, the application will be withdrawn and you will be required to resubmit. This includes the full middle name if the provider has a middle name.

The name on the application must match the National Plan and Provider Enumeration System (NPPES) National Provider Identifier (NPI) and any required licensure, certification, and/or accreditation.

 

 

Type your full legal name until character limit is met.

Type your full legal name until character limit is met.

Email the required legal documentation to NCTracksprovider@nctracks.com. See ACCEPTABLE FORMS OF DOCUMENTATION for more information.

Note: Providers are advised to submit an application only when the name change is complete and can be matched as required. The name on the application must match the NPPES NPI, the IRS tax ID or government issued ID as applicable, and any required licensure, certification, and/or accreditation.

Email the required legal documentation to NCTracksprovider@nctracks.com,  Attention to Finance. See ACCEPTABLE FORMS OF DOCUMENTATION for more information

Note: Providers are advised to submit an application only when the name change is complete and can be matched as required. The name on the application must match the NPPES NPI, the IRS tax ID or government issued ID as applicable, and any required licensure, certification, and/or accreditation.

The Office Administrator (OA) is the person who will assign security roles for your provider entity (the gatekeeper for your access to our system). State Policy requires the OA be an owner or some other individual who has managing authority for the provider or provider entity. An OA is required for accessing the new system’s Provider portal. The portal allows providers to access eligibility information, inquire on claim status, submit claims, and obtain their remittance advices. If the Office Administrator does not have a NCID (North Carolina Management Identifier), visit the NCID Website and establish a NCID.

 

The role of Managing Employee is defined in 42 CFR 420.201:

"Managing employee means a general manager, business manager, administrator, director, or other individual that exercises operational or managerial control over, or who directly or indirectly conducts, the day-to-day operation of the institution, organization, or agency, either under contract or through some other arrangement, whether or not the individual is a W-2 employee."

Providers are encouraged to only include those people who match the federal definition as a managing entity on their enrollment application.

Including people who do not match the definition of a Managing Employee on an application is not just inaccurate, but delays the provider enrollment application process. Remember: Every person listed as a managing entity on a provider enrollment application must undergo a background investigation.

Providers can help expedite the review and approval of their enrollment applications by making sure that everyone listed as a managing entity matches the federal definition.

Public Consulting Group (PCG) is contracted by NC Medicaid to perform the federally mandated screening of Medicaid providers classified as moderate and high-risk (42 CFR 455 Subpart E and NCGS 108C). PCG is also contracted to conduct the NC Medicaid online training component (NCGS 108C-9). PCG sends out the on line training links to all providers and to schedule site visits that are required. Providers can contact PCG at 877-522-1057 for questions and/or concerns.

Yes, you can link multiple NPIs to one Federal ID number.

No, the individual provider does not need to list the service locations of all groups to which they are affiliated.

If the Office Administrator (OA) of the individual provider record is going to remain under another organization, but you want the individual provider to also be able to work at your group location, you will need to work with the OA of the other organization to add the affiliation to your NPI and location on the individual provider's record in NCTracks.

If the individual provider is moving to your group, you will need to become the Office Administrator for the provider. This process is detailed on the NCTracks Provider Portal, in the NCTracks User Setup & Maintenance FAQs. This process will remove the individual provider’s NPI from the OA of the current organization and add it to the new OA (your group).  As the OA, you can manage the provider’s record, and submit a Manage Change Request to create a new affiliation. Note: OA’s must be owners or managing relationships to the individual provider.

When submitting an initial enrollment application in NCTracks, you may select your effective date within the following parameters.  If no date is selected, the system will default tothe current date.

 

The effective date is the earliest date a provider may begin billing for services. The effective date of enrollment may not be more than 365 days prior to the date that a complete Provider Enrollment Packet is received and may not precede, as applicable, the effective date of your required credentials as identified on the Provider Permission Matrix for the requested taxonomy.. The effective date also cannot be more than 90 days in the future.

Yes. Once the enrollment application completes processing, the effective date can be modified by submitting a Back-Dating Manage Change Request Application.  Note: The Begin Date cannot be more than 365 days in the past, and may not precede, as applicable, the effective date of your required credentials as identified on the Provider Permission Matrix for the requested taxonomy.

Supporting documents are requested when needed and can be  be uploaded with your application in the following scenarios:

• Provider Permission Matrix (PPM) Other column indicates a document is required. Example: The Community Behavioral Health Taxonomy Form is required for providers enrolling with the 251S0000X taxonomy code. 
• The PPM indicates that a DEA is required and you do not have a DEA. You must uploaded a DEA Designation Form. See DEA FAQs for more information.
• There is a 6 months or more gap in your work history. See Supplemental Info FAQs.
• You answered “yes” to any of the provider sanction questions. See Exclusion/Sanction FAQs.

If additional information is required for your application after submission, an Application Incomplete Email will be sent to the OA indicating what is required to be uploaded. Providers are advised to monitor their email for notification of additional information needed to complete the application.

 

An individual provider may have their own EIN. The record of an individual provider should reflect their own EIN or Social Security Number (SSN).

No. Please complete the NCTracks Provider EIN Update Form.

All requests sent in will be routed to the NCTracks Enrollment department. The estimated processing time frame is 2 to 3 weeks.

Providers must complete the recredentialing/reverification process every 5 years to ensure that provider information is accurate and current.

See Recrentialing FAQS….

Yes. See the FAQs on Enrollment of Attending, Rendering, Ordering, Prescribing, and Referring Providers for more information.

National Plan & Provider Enumeration System (NPPES) creates and sends a weekly update file to NCTracks containing National Provider Identification (NPI) additions and updates. This file is loaded into NCTracks weekly. Based on the enumeration date, it may take up to four to six weeks for the NPI to be linked to NCTracks. NPI’s will not be visible or searchable by NCTracks staff if the provider has not used NCTracks to enroll in the NC Medicaid program. The only way to know if the NPI is available is to have the provider attempt the enrollment process. During the provider enrollment process on the NCTracks Website the provider may receive an error message that the NPI is invalid. If an error has occurred, please wait a week to see if the NPI is linked to NCTracks.
 

To withdraw an application:

1. Login to the NCTracks Provider Portal.
2. Click the Status and Management button and the Status and Management screen will display. The screen is divided into 6 sections: Submitted Applications, Saved Applications, Re-enroll, Manage Change Request, Re-verification and Maintain Eligibility.
3. Select the Withdraw hyperlink next to the application in the Submitted Applications section.

The provider may submit a Complete MCR to terminate all of their active health plans; doing this will terminate the provider record.

The steps are as follows:

Login to the NCTracks Provider Portal.

Click the Status and Management button and the Status and Management screen will display. The screen is divided into 6 sections: Submitted Applications, Saved Applications, Re-enroll, Manage Change Request, Re-verification and Maintain Eligibility.

To begin a new Manage Change Request, under the Manage Change Request Section, click the Radio button next to the NPI to be changed. Next, click the Update button.

Click the Next button until you reach the Health Benefit Plan Selection page.

On the Health Benefit Plan Selection page go to the Type of Update section.

Use the drop-down next to Update Type and Select Remove Health Benefit Plans.

Under each health plan you will select Yes to indicate that you would like to remove the active health plan.

Enter the date you choose to end each health plan.

Use the drop-down next to Reason for Ending Coverage. Select one of the following reasons:

Voluntary Termination - No longer meets criteria

Voluntary Termination - Closed or out of business

Voluntary Termination - No longer provides services

Provider is terminated due to change in ownership

Continue to click the Next button until you reach the Review Application page. Here you will be able to review your information for accuracy. Once completed, click Next.

On the Sign and Submit Electronic Application page, you will put in your Login ID (NCID), password, and your pin and click Submit Now to complete your Manage Change Request.

 

If the provider has no activity (claim submissions) on any of their active health plans for 12 consecutive months, they will be notified to submit a Maintain Eligibility application.  If not submitted, they will be terminated in NCTracks and will have to re-enroll.

Yes, when a provider is terminated, the access to the NCTracks Provider Portal is not turned off. Provisioned users can still login and check status/history.

Out of State providers, including border-area providers, must be enrolled in Medicare or their home-state Medicaid program in order to enroll in NC Medicaid. If Medicare participation cannot be verified, GDIT will contact the home-state Medicaid program for verification. If Medicare participation is required based on taxonomy, it will be verified for the out of state address, and home-state Medicaid participation will not be required.

Organizations using taxonomy code 193400000X-Single Specialty must have at least one active affiliated individual provider with a Level 1 Taxonomy provider type.

 

Organizations using taxonomy code 193200000X-Multi-Specialty must have: 

• One active affiliated individual provider with two different Level 1 Taxonomy provider types; OR
• Two or more active affiliated individual providers that collectively represent two different Level 1 Taxonomy provider types.

 

Qualifying Level 1 Taxonomy provider types are:

• Allopathic and osteopathic physician
• Behavioral health and social service providers
• Chiropractic providers
• Dental providers
• Dietary and nutritional service provider
• Eye and vision service providers
• Pharmacy service providers
• Physician assistants and advanced practice nursing providers
• Podiatric medicine and surgery service providers
• Respiratory/developmental/ rehabilitative/restorative service providers
• Speech/ language/hearing service providers, or
• Student healthcare providers

Organizations using taxonomy code 261QP2300X -Primary Care must have at least one active affiliated individual provider representing a Doctor of Medicine (MD), Doctor of Osteopathic Medicine (DO), Nurse Practitioners (NP), Physician Assistant (PA), or Certified Nurse Midwife (CNM).

 

An individual to organization affiliation is required for each NPI and service location with an active Single specialty, Multi-specialty, or Primary Care taxonomy as indicated above. 

 

For more information, see https://medicaid.ncdhhs.gov/blog/2022/10/10/organizational-provider-records-without-required-individual-provider-affiliation-risk

Submit a MCR selecting to end-date the taxonomy code 193200000X-Multi-Specialty and add taxonomy code 193400000X-Single Specialty.  Be sure the one provider is affiliated to the organization NPI and all locations as applicable.

Re-verification, re-credentialing, and re-validationare 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 meet the professional requirements and remain in good standing. The re-verification process also includes a criminal background check on all owners and managing relationships associated with this provider record. Providers are required to pay a $100 fee as part of the re-verification process. Providers also may be required to complete fingerprinting, a site visit, and the federal fee depending on their risk level (please see the Provider Permission Matrix under Quick Links on the Provider Enrollment page to determine whether it is a requirement).

 

For more information about the re-verification process, go to https://www.nctracks.nc.gov/content/public/providers/provider-recredentialing.html   

On-going verification only occurs when a provider license or certification is about to expire. 60 days before the provider accreditation or license expires, CSRA will send the provider a notice to complete a MCR to update the accreditation or license information. Although CSRA may receive information from licensing boards to automatically update the provider record, it is the responsibility of the provider to ensure their credentials are updated before they expire.  On-going verification is completed using the MCR application. When completing on-going verification, the provider will simply start a new MCR application and update the license # or expiration date. Some licenses or certifications expire annually. There is no cost to complete on-going verification of an existing credential.

For more information about updating licensure, see https://www.nctracks.nc.gov/content/public/providers/faq-main-page/Updating-Provider-Licenses-FAQs.html.

 

A provider will be required to complete a "Maintain Eligibility" application if he/she does not submit claims within a twelve-month period. This process is used to verify that the provider record is still active. CSRA will send the provider a notification in the messaging center asking the provider if he/she wishes to remain active. If the provider does not complete the Maintain Eligibility application, the provider’s health plans (except DMH) will be terminated. If NCTracks terminates some, but not all of the provider’s health plans, the provider will be required to submit a Manage Change Request Application to reinstate the health plans to participate in DHB or DPH health plans in the future. If all of the Health Plans are terminated, the provider will have to submit a re-enrollment application.