Re-credentialing and 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 requirements to participate in the NC Medicaid program. The re-verification process also includes a criminal background check on all owners and managing relationships associated with this provider record.

 

Providers will receive a notification via their NCTracks secure portal Provider Message Inbox when they are scheduled to begin the re-verification process.

 

Note: Providers may be required to complete fingerprinting, a site visit and the federal fee depending on their risk level and date of last screening.

This report is updated monthly and offers reverification due dates over a period of twelve (12) months. Although the reverification deadline will not change once the reverification application is submitted, changes to the provider enrollment record may impact future reverification timelines. Providers are encouraged to review and respond to all notification received through the secure NCTracks Provider Message Inbox.

A provider is given 70 calendar days from the initial notification date to submit the re-verification application.

 

The re-verification application must be submitted, and applicable fees paid, by or before 4pm on the due date in the initial notification; otherwise, the provider record will be suspended, and claims will pend. The provider will receive a suspension letter through regular mail, as well as via the NCTracks message center inbox.

 

Providers must understand the risk of delaying submission.

 

Corrections cannot be made to any application once submitted. Any errors or omissions in a reverification application can result in the application being denied by NCTracks. Additionally, the provider has the option to withdraw an application that contains errors. Providers who have responded promptly to the reverification notice have ample time to re-submit. Providers are advised against waiting until a suspension has been placed on their record to submit the reverification.

 

At the point of suspension, the reverification due date has passed. Any submission beyond that date is delinquent and places the provider at risk of termination. Re-enrollment is required to continue participation in NC DHHS programs.

No, Providers may review and update their provider record (including required accreditation, certification and license data), during the re-verification process.  For specific information regarding the updatable portions of the record during re-verification, see the How to Complete Re-verification in NCTracks user guide.

Providers may have only one pending application per NPI and are advised not to begin an MCR when the reverification option is available. Instead, complete updates during the record review required in the reverification application.

 

Any additional updates can be made through a Manage Change Request (MCR) application once the reverification process is complete.

Providers begin receiving notifications 70 days in advance of the due date to submit their re-verification application to avoid suspension. Providers are encouraged to begin the process immediately. If suspended for failure to complete re-verification, the provider will receive a suspension notice informing them of the date they must submit the reverification application to avoid termination.

Per 42 CFR 455.414, actively enrolled NC Medicaid providers are required to complete the re-verification process through NCTracks at least every five (5) years. Exception is made for Out-of-state (OOS) Lite, Medicare Lite, Disaster Relief providers due to their time limited enrollment type; and for Managed Care Organizations/Preferred Provider Organizations due to their limited purpose enrollment.

 

Processing time may vary depending on if additional information is required. You will be contacted if additional information is needed.

NC General Statute 108C-2.1(a) mandates: (a) Each provider that submits an application to enroll in the Medicaid program shall submit an application fee. The application fee shall be the sum of the amount federally required and one hundred dollars ($100.00). (b) The fee required under subsection (a) of this section shall be charged to all providers at re-credentialing every five years.

 

Providers also may be required to complete fingerprinting, a site visit, and pay the federal fee depending on their risk level and date of last screening/payment. See the Provider Permission Matrix and the Federal Fee & NC Enrollment Fees by Year under Quick Links on the  Provider Enrollment page to determine the risk level for the enrolled taxonomy and the current amount of the Federal Fee.

The NC Application fee is non-refundable. Please ensure the information entered on the provider application is correct, and report all appropriate disclosures pertaining to exclusion sanction questions, particularly findings that may arise from background checks.

The federal fee is non-refundable. 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.

 

For more information about the federal fee, please see the Federal Fee and NC Application Fee FAQs - Federal Fee and NC Application Fee FAQs.

An office administrator (OA), managing relationship user (MR), or someone who has been designated as the Enrollment Specialist (ES) for the provider can complete the re-verification. More information about user roles can be found on the Office Administrator, User Setup & Maintenance FAQs - Office Administrator, User Setup & Maintenance FAQs.

Providers are unable to submit a re-verification applications when an MCR is in review.  Depending on the re-verification due date, you may consider withdrawing the MCR and submitting the re-verification application instead, making the necessary record updates through the re-verification application. 

Yes, as long as you are currently “active” and the re-verification application is in review status, you may continue to bill and receive payment for claims submitted.  It is imperative to regularly review the NCTracks secure Provider Message Inbox for additional notifications regarding the pending application.

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.

The number ID for a re-credentialing letter is PM16000-R0053, with the description “Re-verification Letter”. We advise thoroughly reading all messages sent to the Message Center Inbox.

Enrollment, re-enrollment and/or re-verification applications in draft may be periodically deleted due to system updates required to complete changes in NCTracks. Providers are notified in advance of these instances so they may complete their draft application before the update.

A request for supporting documentation will be sent to the secure NCTracks Provider Message Inbox. It is imperative to regularly review Inbox for additional notifications regarding the pending application.

At the end of the application, the Upload Documents page will allow the provider to upload supporting documentation if necessary, such as copies of certifications. After application submission, providers may upload documents using the Upload hyperlink on the Status and Management page available while the application is pending.

If requested by NCTracks, instructions will be included in the request for additional information. More information about how education is verified can be found at Use of State License Boards Instead of Transcript to Verify Education and Training - Use of State License Boards Instead of Transcript to Verify Education and Training.

If your re-verification application is denied, all NC DHHS health plans will terminate. Providers may re-enroll at any time, requesting an effective date adjacent to the termination date (up to 365 days retroactive) to avoid a gap in participation.

The name listed in the Identifying Information section of the NCTracks application must match the organization or individual provider’s legal name, name on the NPPES Registry, and on any required license, certification, and/or accreditation.

 

Providers can check their listed NPPES name at: https://npiregistry.cms.hhs.gov/search

 

If the name does not match, do NOT submit the application. Instead send an email to NCTracksprovider@nctracks.com with required documentation attached. See chart on this page: NCTracks Helpful Hints: What is the Process to Update a Name, DOB and/or SSN on a Provider's Record?

Your enrollment with all NC Department of Health and Human Service (NC DHHS) health plans will terminate, and you will be required to submit a re-enrollment.

If requested by NCTracks, instructions will be included in the request for additional information. 

If your re-verification is denied due to a negative background finding, failure to complete fingerprinting, bad data, or expired credentials (license/accreditation/certification per the Provider Permission Matrix), all NC DHHS health plans will be terminated.

The provider name listed on applications for re-verification must match their legal name, name on the NPPES Registry, and their name on any license, certification, and/or accreditation.

 

Providers can check their listed NPPES name at: https://npiregistry.cms.hhs.gov/search

 

If the name does not match, do NOT submit the application. Instead send an email to NCTracksprovider@nctracks.com with required documentation attached. See chart on this page: https://www.nctracks.nc.gov/content/public/providers/provider-communications/2022-Announcements0/NCTracks-Helpful-Hints--What-is-the-Process-to-Update-a-Name--DOB--and-or-SSN-on-a-Provider-s-Record-0.html

A provider is given 70 days from the initial notification date to complete the re-verification. Providers who act promptly upon receiving the notice have ample time to resubmit if their application is denied (unless as indicated below), withdrawn, or abandoned.

 

Do not wait to submit. Take advantage of the 70-day timeframe given to ensure completion without adverse action.

 

The Reverification must be completed, and applicable fees paid, by or before 5pm on the due date; otherwise, the provider record will be suspended, and claims will pend. The provider will receive a suspension letter via regular mail to the correspondence address on record as well as via the NCTracks message center.

 

Providers must understand the risk of delaying submission.

 

Corrections cannot be made to any application once submitted, so any errors or omissions in a reverification application can result in the application being abandoned, denied or withdrawn. Providers who have responded promptly to the reverification notice will have ample time to re-submit. Providers are advised against waiting until a suspension has been placed on the record to submit the reverification, because at the point of suspension, the reverification due date has passed.  Any submission beyond that date is delinquent and places the provider at risk of termination. After the suspension date, if a reverification application contains errors or omissions that result in the application being abandoned, denied or withdrawn, the provider’s NCTracks enrollment record automatically terminates. Re-enrollment is required to continue participation in DHHS programs.

Your enrollment with all NC Department of Health and Human Service (NC DHHS) health plans will be terminated, and you will be required to submit a re-enrollment application if you wish to continue to render services for any NC DHHS plan, including NC Medicaid, Department of Public Health, Office of Rural Health, or Division of Mental Health/Developmental Disabilities/Substance Use services.

NCTracks does not send denial letter notifications for denied re-verification applications. However, providers will receive a notification if they are terminated for failure to complete re-verification.