Provider Enrollment and Credentialing FAQs

The provider’s full legal name should be entered on the application according to their government issued identification. If the full legal name is not on the application, the application will be withdrawn, and you will be required to resubmit.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), the IRS tax ID or government issued ID as applicable, and any required licensure, certification, and/or accreditation.

Type the organization’s full legal name until character limit is met.

Type your full legal name, matching your government issued identification, 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. The legal name on the application must match the IRS tax ID name.  In addition, all NCTracks provider records with the same IRS Tax ID will have the same legal name.  Providers may use the DBA or Service Location name fields if other names are appropriate for the rendering service locations. 

 

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

The Office Administrator (OA) is the primary person who can assign security roles for your provider record. State Policy requires the OA be the provider, an owner, or managing employee. 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 only inaccurate, but potentially 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 site visit 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 newly enrolling provider training component (NCGS 108C-9). PCG sends out the online training links to all providers and schedules site visits that are required.

 

If providers fail to complete their site visit or new provider training by the deadline given, the application will automatically be denied. Providers can contact PCG at 877-522-1057 for questions and/or concerns.

Yes, you can link multiple NPIs to one Federal ID number. All NCTracks provider records with the same federal ID will have the same legal name.  Providers may use the DBA or Service Location name fields if other names are appropriate for the rendering service locations. 

Although Individual to Organization affiliations should accurately represent the location(s) the provider regularly renders services; the claims adjudication process only requires an affiliation to the organization, any location. Individual providers do not need to affiliate to all service locations within the organization.

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 at least one location on the individual provider's record in NCTracks.

 

If the individual provider is moving to your group, you may need to change the Office Administrator for the provider. This process is detailed on the NCTracks Provider Portal, in the NCTracks Office Administrator, 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: The OA must be listed on the NCTracks provider record as the provider, owner, or a managing employees.

When submitting an initial enrollment application in NCTracks, you may select your effective date within the following parameters:

 

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 enrollment application is submitted and may not precede, as applicable, the effective date of the required credentials. The effective date also cannot be more than 90 days in the future.  If no date is selected, the system will default to the current date.

Once the enrollment application completes processing, the effective date can be modified by requesting approval for backdating the enrollment effective date through the NCTracks secure Provider Portal. See the Request to Back-Date Enrollment Effective Dates Job Aid for guidance. Important things to note:            

 

• Only the provider’s OA will have access to the backdate request page
• The backdate request application will not have a save draft feature. The request must be submitted in one session

The backdate request application will not allow the user to request a new begin date if the date precedes the provider’s required license, certification, or accreditation begin date(s) on file or is more than 365 days in the past.

Supporting documents are identified and requested throughout and at the end of the application when needed, and can be uploaded with your application with submission or after submission using the Upload feature on the NCTracks Status and Management page. Examples of a need to upload supporting documents can include:

 

• The Provider Permission Matrix (PPM) Additional Documents Required column  indicates a  document is required.
• The PPM indicates that a DEA is required and you do not have a DEA. You must upload a DEA Designation Form. See DEA FAQs for more information.
• There is a 6 month or more gap in your work history. See Provider Supplemental Info FAQs.
• If you answered “yes” to any of the provider sanction questions. See Exclusion Sanction Question 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 for a clean form is  2 to 3 weeks.  If additional information is required to process the form, a notification will be sent to the provider. Providers may call the NCTracks Contact Center to check the status of their application.

Providers must complete the recredentialing/reverification process every 5 years to ensure that provider information is accurate and current. See Provider Re-credentialing/Re-verification FAQs for more information.

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. The only way to know if the NPI is available for enrollment through NCTracks 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 message has occurred, please reach out to the NCTracks Contact Center for assistance.

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, their participation will be terminated in NCTracks.

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.

The NPI and location of 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 of active status. 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   

 

Ongoing verification only occurs when a provider license or certification is about to expire. 60 days before the provider’s accreditation or license expires, NCTracks 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.  Credential updates are completed using the MCR application. When updating a credential, the provider will simply start a new MCR application and update the license, accreditation, or certification and expiration date. There is no cost to update an existing credential.

 

For more information about updating licensure, see the Updating Provider Licenses FAQ. 

 

A provider will be required to complete a "Maintain Eligibility" application their NPI is not used on a claim submission 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 NCTracks messaging center asking the provider if there is an intent 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 must submit a re-enrollment application.