Enhanced Screening of Owners and Managing Employees for Organization Enrollment

Effective April 24, 2022, NCTracks will implement enhanced safeguards for providers in relation to organization enrollment applications:

NCTracks will screen and verify organization owners, agents and managing employees listed on initial enrollment applications. 

  • All owners, agents and managing employees on initial enrollment applications with one or more in-state service location must match the owners disclosed in the Medicare Provider Enrollment, Chain and Ownership System (PECOS).
  • All owners that are listed in PECOS must be listed on the initial enrollment application.

 

In addition, attestation statements (checkboxes for the provider to select, review and acknowledge on certain pages of the application) will be required for organizations on applications when selecting a business type or adding owners, agents and/or managing employees.

  • Attestations will be required on enrollment, re-enrollment, manage change request (MCR) and re-verification applications.
  • Providers will attest to certain items in relation to the stage in the application:
    • Organization Basic Information page/Ownership Information: The business type entered on this application matches what was reported to the provider’s state business registration entity.
    • Ownership Information page: Owners with 5% or more ownership in the enrolling provider entered on this application match what was reported to the provider’s state business registration entity, licensure board and Medicare.  
    • Agents and Managing Employees page: Managing agents and employees entered on this application match what was reported to the provider’s state business registration entity, licensure board and Medicare.  
  • NC Medicaid will compare the owners and managing employees entered on this application with the owners and managing employees listed on the provider’s Medicare enrollment record when applicable.

 

These enhanced verification processes will help protect the validity of Medicaid and NC Health Choice provider networks as well as further safeguard from potential fraud.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

M22101-R-2481