Maintain Eligibility Process

[Article reprinted from the August 2017 Medicaid Bulletin]

Effective October 29, 2017, NCTracks will implement a quarterly Maintain Eligibility Process which identifies providers with no claim activity within the past 12 months. NCTracks will notify the provider via the secure provider portal mailbox. The provider must attest electronically to remain active.

When a provider is identified with having no claims activity in 12 months, a Maintain Eligibility Due Date will be set. Providers will be notified 30 days before the due date that they must submit a Maintain Eligibility Application. Upon submission of the Maintain Eligibility Application, the provider’s enrollment record will be updated with the current date.

If the provider does not submit the application by the due date, the provider’s participation in the N.C. Medicaid and N.C. Health Choice (NCHC) programs will be end dated. This will prevent fraud, waste and abuse in the N.C. Medicaid and NCHC programs.