Behavioral Health Provider Enrollment FAQs

This page includes a list of answers to frequently asked questions (FAQs) regarding behavioral health provider enrollment.

  • 1. Why are Behavioral Health Providers required to enroll in NC Medicaid/North Carolina Health Choice?

    On April 25, 2016, the Centers for Medicare & Medicaid (CMS) issued final regulations that revise and significantly strengthen existing Medicaid managed care rules.  As a result, 42 CFR 438.608 (b) Provider screening and enrollment requirements, 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.

  • 2. When are Behavioral Health network providers required to enroll via NCTracks?

    Effective July 1, 2017, Behavioral Health providers not currently enrolled in NCTracks were required to enroll via the NCTracks Provider Enrollment Online Application. This included providers who did not have an active record in NCTracks as of June 30, 2017 via the Provider Upload process. The Upload process ended at 12:00 a.m. on  June 30, 2017. Effective July 1, 2018, LME-MCO network Behavioral Health providers who have an active record in NCTracks via the Upload process will be required to be re-credentialed via the NCTracks Provider Enrollment Online Re-Credentialing Application.

  • 3. Are there fees associated with provider enrollment in NCTracks?

    Session Law 2011-145 Section 10.31 (f) (3) Provider Enrollment Fee, mandated DHB collect a $100.00 application fee from providers upon initial enrollment, re-enrollment, re-credentialing/re-verification. Section 6401 of the Affordable Care Act (ACA) mandated DHB collect a federal application fee from certain Medicaid and N.C. Health Choice (NCHC) providers. The Centers for Medicare & Medicaid Services (CMS) sets the application fee, which may be adjusted annually. The application fee for enrollment in calendar year 2018 is $569. The fee is used to cover the cost of provider enrollment screenings and other program integrity efforts. The application fee will be collected at initial enrollment, re-enrollment, re-credentialing, and subsequently when a provider adds a new site location. Initial enrollment is defined as an in-state or border-area provider who has never enrolled to participate in the N.C. Medicaid/Health Choice programs. The provider's tax identification number is used to determine if the provider is currently enrolled or was previously enrolled. Providers initially enrolling or re-enrolling in the N.C. Medicaid or NCHC program who do not pay the fee within 30 days of receipt of invoice will have their applications voided through NCTracks.  Providers in border states located within 40 miles of N.C. who have paid the fee to their home state will be required to provide proof of payment.

  • 4. For applications transmitted but not yet processed by NC TRACKS off the Provider Upload Process (PUP) file by 7-1-17, what will happen? What is the latest date a provider can submit a PUP and expect it to be processed?

    LME/MCOs were able to submit a PUP for a new provider through June 30, 2017.

  • 5. Are Behavioral Health providers required to submit fingerprints for purposes of completing a criminal background check?

    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 the NC Medicaid and Health Choice Program. Under Medicare regulations at 42 CFR 424.518 (c), newly enrolling home health agencies and newly enrolling Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) suppliers are designated "high"risk. N.C.G.S 108C-3 further defines providers that are impacted in North Carolina. For more information, see the Fingerprinting FAQ page.

  • 6. Is the mandated training required for an existing provider adding a site?

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

  • 7. What is the difference between the re-credentialing/re-verification, on-going verification and maintain eligibility processes?

    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 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 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 ($569 for calendar year 2018) 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).

     

    Providers will receive a re-credentialing/re-verification letter, or an invitation via their NCTracks secure portal in-box or e-mail when they are scheduled to begin the re-verification process. This process is completed in the “Status and Management” section, directly below the Manage Change Request (MCR) application under the section titled “Re-verification.” A re-verification application will appear when it is time to re-verify. Until then, the “Re-verification” section will read “No Data to Display.” Effective April 29, 2018, the only exception to this is updating owners’ and managing employees’ information (address, phone number, email) prior to re-verification. Updating these records is incorporated into the re-verification application process so that providers are able to do it during the application without submitting an MCR to update these records beforehand.

     

    On-going verification only occurs when a provider license or certification is about to expire. Effective April 29, 2018, 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. 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. Accreditations typically do not expire.  There is no cost to complete on-going verification. Please note that effective April 29, 2018, re-verification due dates will not be extended if an MCR is in review. Therefore, submitting an MCR (for any update) prior to re-verification will decrease the time left to complete the application before its due date, as you cannot access a re-verification application while an MCR is being processed.

     

    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. When a provider has not billed claims within twelve months, 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 DMA 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.

  • 8. How do I update my accreditation(s) using a Manage Change Request?

    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."

  • 9. If I add a taxonomy to my provider record, is it effective immediately?

    No. Adding a taxonomy code may require verification of provider credentials.

  • 10. What is an Office Administrator?

    The Office Administrator (OA) is the person who will assign security roles for your provider entity. 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 NCTracks Provider portal. The OA must have an NCID (North Carolina Management Identifier) to access the Provider Portal. The portal allows providers to access eligibility information, inquire on claim status, submit claims, and obtain their remittance advices.

  • 11. Is the NCTracks process taking the place of the MCO credentialing process?

    Effective July 1, 2017, Behavioral Health providers who are requesting initial enrollment through a LME/MCO will be required to enroll via NCTracks. LME/MCO credentialing is independent of provider enrollment/credentialing via NCTracks.

  • 12. What elements can the LME/MOC amend on the future Provider Upload Process (PUP) files after 7-1-17? Will the PUP file even exist after this date?

    Effective 7-1-17, LME/MCOs can amend provider records that are active in NCTracks.  

  • 13. What will be included in the enrollment files from NC TRACKS shared with the LME/MCOs?

    LME/MCOs will continue to receive the data they are currently receiving.

  • 14. If the PUP file still has elements after 7-1-17 will the caveat still be that a PUP file will not upload anything for a provider if they have a Manage Change Request (MCR) pending with NCTracks?

    Yes, there are no plans to change the existing process.

  • 15. What will be the provider/site/rendering active date that is approved by NC TRACKS be set in to in the system, the submission date or approval date?

    Neither.  It is the effective date requested by the provider.

  • 16. Regarding unlicensed AFL’s and Therapeutic Foster Care, It is our understanding that we cannot enter an address that is an unlicensed facility (Example 1 bed) into NCTracks and that we can ONLY enter Licensed facilities.

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

  • 17. Will the Notice of LME-MCO Credentialing/Re-credentialing Action Form (NCA) be required after July 1, 2017?

    No.  Effective July 1, 2017, the Notice of LME-MCO Credentialing/Re-credentialing Action Form is no longer required.