Provider Re-credentialing/Re-verification FAQs

Re-credentialing is sometimes referred to as re-verification 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 (application fee in calendar year 2018 is $569) 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, 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 application under the section titled “Re-verification.” A re-verification application will appear when it is time to reverify. Until then, the “Re-verification” section will read “No Data to Display.”

Effective April 29, 2018, making updates to owners’ and managing employees’ information (address, phone number, and/or email) is incorporated into the re-verification application process. Therefore, there is no need to submit an MCR to update these records before beginning the re-verification application. Any other updates (accreditations, licenses, certifications, etc.) need to be completed through an MCR.

Please also note that the due date for the re-verification application will not be extended if the provider has an MCR (for any update) in review — therefore, if it is close to the time to re-verify, it is advised not to begin an MCR, but instead complete accreditation/license/certification record changes after the re-verification application has been completed for simpler and more efficient processing that will allow the application to be submitted before the due date.

Providers will be notified of the due date to submit their re-verification application to avoid suspension. Effective April 29, 2018, providers are allowed 70 days to submit and avoid suspension instead of 45 days. If suspended for failure to complete re-verification, the provider will be notified of the date they must submit by to avoid termination.

All actively enrolled Individual and Organizations/Atypical Organizations with the exception of providers enrolled with a Department of Mental Health (DMH) only health plan. All providers that were enrolled by the LME/MCO, and re-credentialing does not apply to any time-limited enrolled providers such as out-of-state (OOS) providers. OOS providers must continue to complete the enrollment process every 365 days.

Processing time may vary depending on if additional information is required. You will receive an email or a phone call if additional information is needed.

Providers must update their expiring licenses, certifications, and accreditations through a Manage Change Request (MCR) if their records are not up to date. The system suspends and terminates providers who fail to respond within the specified time limits for accreditations/credentials/licenses updates as well.

 

Effective April 29, 2018, provider notifications to renew or update licensure, accreditation and/or certification are sent 60 days prior to the date of expiration of the license, certification, or accreditation on file. If the provider fails to renew update by the expiration date, the provider’s participation will be suspended for 60 days.

 

If the provider fails to renew during the 60-day suspension period, the taxonomy code(s) for which the license is required are terminated. Please note that if the license number on file (printed on the letter) is correct, and it is a NC Medical Board MD/PA/AA license, it will be updated automatically. Clinical Laboratory Improvement Amendments (CLIA) certifications will also be updated automatically. Licenses, certifications, and accreditations must be up to date to complete a re-verification/re-credentialing application.

A $100 NC Application Fee is required from individual and organization for re-verification application. A $100 NC Application Fee is also required per tax ID from organizations and atypical organizations if active in Medicaid and/or NCHC.

Providers also may be required to complete fingerprinting, a site visit, and the federal fee (application fee in calendar year 2018 is $569) 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). There is no fee to submit an MCR to update licenses, certifications, and accreditations.

 

This is a non-refundable fee.

The federal fee is a non-refundable fee. However, if a provider has paid the federal fee on a previous application and/or completed a federal site visit but that application was withdrawn, abandoned, or denied, they may be able to avoid doing so again when submitting a new/second application. Providers should indicate they have already paid the fee and/or completed the site visit following the process of providing adequate proof outlined below.

On the new application, when you are presented with the question, “Have you paid the Federal fee for this site to another state or Medicare?” you must do the following:

1. Select “Other State”
2. Select “North Carolina” from the State drop down menu
3. Attach the federal fee payment confirmation from the previous application

On the new application, when you are presented with the question, “Have you completed the Federal site visit for this site to another state or Medicare?” you must do the following:

1. Select “Other State”
2. Select “North Carolina” from the State drop down menu
3. Attach a statement identifying the previously denied, withdrawn, or abandoned application’s NPI and application submission date, including the reference number if available

Please note: If the confirmation of the completed and passed Federal site visit or statement is not uploaded with the new application submission, the application will be deemed incomplete for 30 days. If the required information is not received within 30 days of the incomplete notice, the application will be abandoned.

A newly enrolled provider will not have to complete a re-credentialing/re-verification application for five years.

An Office administrator (OA) or someone who has been designated as the Enrollment Specialist (ES) for the provider can complete the re-verification.

If you have answered yes to any of the provider sanction questions, at the end of the application you must upload or submit a complete copy of applicable criminal complaint or disciplinary action, consent order, documentation regarding recoupment/repayment settlement action, and/or final disposition clearly indicating the final resolution.

You will be required to submit a re-enrollment application if you wish to continue to render services with NC Medicaid.

If there are any expiring accreditations, licenses, and/or certifications on the provider record, providers will be prompted to update this information via a MCR prior to completing the re-verification application. Once the MCR has been completed and approved, then the provider will be able access and submit a re-verification application. Effective April 29, 2018, the only exception to this is updating owners’ and managing employees’ information (address, phone number, email). 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.

 

Please note that in accordance with this, 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.

Providers are unable to access re-verification applications when an MCR is in review. Therefore, it is important to note the re-verification due date prior to submitting an MCR. Please note that effective April 29, 2018, updates to owners’ and managing employees’ information (address, phone number, email) are incorporated into the re-verification application process, so no MCR to update these records is necessary prior to re-verification. Providers are advised not to submit an MCR (for any update) close to the time for re-verification, as these updates can be made during the application process. Submitting an MCR 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.

Yes, as long as you are currently “active” and have an MCR in review status, you may continue to bill and receive payment for claims submitted.

You may submit your question to the NCTracks Call center by Email NCTracksprovider@nctracks.com or you may call the NCTracks Call Center Toll Free Number 1-800-688-6696.

Effective April 29, 2018, subject lines for many enrollment-related letters in the provider Message Center Inbox display the description of the letter instead of the number ID. The number ID for a re-credentialing letter is PM16000-R0053, with the description “Re-verification Letter”.