Enrollment Broker Provider Directory Updates

The Enrollment Broker has implemented updates to the Provider Directory search on their website intended to provide more accurate information when searching for a practice. 

Issues and planned changes with the Provider Directory were communicated in a September Medicaid Special Bulletin.

NOTE: the references below that refer to “PCP” include:

  • AMH-tiered practices/groups 
  • AMH-tiered sole practitioners
  • Non-AMH-tiered practices/groups/ sole practitioners that are contracted as a PCP by a PHP;
  • Medicaid Direct CA and CCNC enrolled practices/groups/sole practitioners

 

Changes have been implemented and are summarized here:  

  • Searching for providers will be limited to include results for PCP’s only;
  • Searching on non-PCP will no longer return search results;
  • Individual providers (other than PCP sole practitioners/CA/CCNC) will no longer return search results;
  • Searching for a practice/group/sole practitioner was enhanced to return results based on the NCTracks Service Location Name, Doing Business As (DBA) Name, or Organization Name – in that order, so searches will utilize the more commonly-known practice name. 

 

Q: If a beneficiary can’t find me - an individual rostered PCP doctor – does that affect their selection or assignment of me as their PCP?

A: No, the beneficiary does not select an individual rostered doctor as their PCP, they select the PCP (according to the definition of PCP above). That’s how it works in NCFAST for Medicaid Direct PCP selection today. If a beneficiary cannot find a PCP by their practice name, they should try a search by the individual name or contact the EB Call Center for assistance.

More information about issues with the Enrollment Broker Provider Directory are available in the:

Please be sure to disseminate the above information widely within your organization, so all your staff are aware of the changes