Provider Enrollment FAQs

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 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 DHB 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.

Some providers are being prompted to complete re-verification, even though they may have submitted a re-verification application and paid the re-verification fee within the past five years. 
 

The re-verification process requires the provider to submit certain supporting documentation in order to complete the re-verification process. If the provider does not comply with the request for supporting documentation, his/her re-verification application will terminate. In this scenario, if the provider initiates the re-verification process again, he/she will be required to pay another $100.00 fee. 
 

If the provider was unable to complete the re-verification process due to no fault of their own, such as a system issue or other event, the provider will still be required to pay the $100.00 fee to initiate the process. However, CSRA will reimburse the provider the re-verification fee.

The NCTracks Registration provide the system with important information needed: 1) your Office Administrator (OA); 2) the bank account number for Electronic Funds Transfer (EFT) payments; and 3) your intended method of submitting claims.

The Office Administrator (OA) is the person who will assign security roles for your provider entity (the gatekeeper for your access to our system). 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 new system’s Provider portal. The portal allows providers to access eligibility information, inquire on claim status, submit claims, and obtain their remittance advices. If the Office Administrator does not have a NCID (North Carolina Management Identifier), visit the NCID Website and establish a NCID.

The role of Managing Employee is defined in 42 CFR 420.201:

"Managing employee means a general manager, business manager, administrator, director, or other individual that exercises operational or managerial control over, or who directly or indirectly conducts, the day-to-day operation of the institution, organization, or agency, either under contract or through some other arrangement, whether or not the individual is a W-2 employee."

Providers are encouraged to only include those people who match the federal definition as a managing entity on their enrollment application.

Including people who do not match the definition of a Managing Employee on an application is not just inaccurate, but delays the provider enrollment application process. Remember: Every person listed as a managing entity on a provider enrollment application must undergo a background investigation.

Providers can help expedite the review and approval of their enrollment applications by making sure that everyone listed as a managing entity matches the federal definition.

Public Consulting Group (PCG) is contracted by NC Medicaid to perform the federally mandated screening of Medicaid providers classified as moderate and high-risk (42 CFR 455 Subpart E and NCGS 108C). PCG is also contracted to conduct the NC Medicaid online training component (NCGS 108C-9).

Yes, beginning July 1, 2013, claims will be denied if a provider is not registered through NCTracks.

Completing the registration only requires a few minutes, after which we will submit a pre-note transaction to the bank to verify your Electronic Funds Transfer (EFT) information. Once the bank receives your information, please allow 4 to 6 business days for processing.

If you have misplaced your Currently Enrolled Provider (CEP) registration letter with your authorization number, please contact the Call Center at 1-800-688-6696. Providers cannot complete CEP registration without the authorization number.  CEP registration is required to identify the Office Administrator for your organization, to designate your billing agent (if applicable), and to provide your Electronic Funds Transfer (EFT) information for claims payment.

No.  Adding a taxonomy code requires verification of provider credentials.

Yes, you can link multiple NPI's to one Federal ID number.

Yes, the individual provider does need to list the service locations of all groups to which they are affiliated.

If the individual provider is going to remain enrolled under another organization, but you want the individual provider to also be able to work at your group location, you will need to work with the Office Administrator (OA) of the other organization to add your NPI and location to the individual provider's record in NCTracks.

 

If the individual provider is moving to your group, you will need to become the Office Administrator for the provider. This process is detailed on the NCTracks Provider Portal, in the NCTracks User Setup & Maintenance FAQs. This process will remove the individual provider’s NPI from the OA of the current organization and add it to the new OA (your group).  As the OA, you can manage the provider’s record, and submit a Manage Change Request to create a new affiliation. Note: OA’s must be owners or managing relationships to the individual provider.

When submitting an initial enrollment application in NCTracks, the system will assign a default effective date of the current date. This is important because the system will edit subsequent transactions against the effective dates in the provider record.  Some effective dates can be changed from the default date, while others cannot. See the Provider Enrollment webpage on the DHB website for more information.

DHB will consider specific requests for retroactive effective dates if a beneficiary has been granted retroactive eligibility, an emergency service was provided, or medically necessary services were rendered and the provider's credentials, licensure, certifications, etc. were active and in good standing for the earliest effective date of service. DHB cannot provide special consideration for processing of enrollment applications due to provider error, incomplete information, or due to a delay in obtaining credentialing, endorsement or licensure information from another agency.

Go to the Provider User Guides and Training page of the NCTracks Provider Portal and open either the "How to Enroll in North Carolina Medicaid as an Individual Practitioner" or "How to Enroll in North Carolina Medicaid as an Organization" User Guides located in the Enrollment and Re-Verification section. There is a hyperlink located in the Exclusion Sanction Information section of these documents that will display a complete list of the questions. Please note that effective July 26, 2020, additional exclusion sanction questions will be added to initial enrollment, re-enrollment, re-verification applications and manage change requests (MCRs) for individual providers (excluding disaster relief and Out-of-State Lite providers).

 

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. Effective July 26, 2020, additional supporting information may be required based on application responses. Please see the the link under Resources at the top right of this page for applicable additional information.

Effective July 26, 2020, all individual providers are required to download the Individual Provider Agreement, sign the agreement, scan or take a photo of the signed agreement and upload the agreement on the Upload Documents page. This Individual Agreement is signed by the provider to testify that the answers they have provided are accurate. Individual providers are required to physically sign and upload the Individual Agreement themselves; the office administrator (OA) cannot complete this for them. This will be accessible through two locations within the provider record, the Final Steps page and the Upload Documents page.

NCTracks is collecting this additional information to assist in streamlining the data collection process for providers and Prepaid Health Plans (PHPs) to facilitate network eligibility determinations.

If you are a rendering provider only (which means you only perform services for an organization and not for your private practice) and the EIN listed in your record belongs to the organization, please complete the NCTracks Provider EIN Update Form.

 
If you provide services both at your own private practice and for an organization and the EIN listed on your record does not belong to you, please complete the NCTracks Provider EIN Update Form.
 

An individual provider may have their own EIN. The record of an individual provider should reflect their own EIN or Social Security Number (SSN).

Please complete the NCTracks Provider EIN Update Form.

All requests sent in will be routed to the NCTracks Enrollment department. The estimated processing time frame is 2 to 3 weeks.

Yes, the Pay To Address must be entered even if it is the same as the primary address.

The provider needs to put in the CDSA certification. Providers will not need to affiliate to the CDSA.

See the FAQs on Enrollment of Attending, Rendering, Ordering, Prescribing, and Referring Providers for more information.

National Plan & Provider Enumeration System (NPPES) creates and sends a weekly update file to NCTracks containing National Provider Identification (NPI) additions and updates. This file is loaded into NCTracks weekly. Based on the enumeration date, it may take up to four weeks for the NPI to be linked to NCTracks. NPI’s will not be visible or searchable by NCTracks staff if the provider has not used NCTracks to enroll in the NC Medicaid program. The only way to know if the NPI is available is to have the provider attempt the enrollment process. During the provider enrollment process on the NCTracks Website the provider may receive an error message that the NPI is invalid. If an error has occurred, please wait a week to see if the NPI is linked to NCTracks.
 

You may send a written request on your company letterhead requesting to have the application withdrawn. The letter should include the provider’s name, NPI, reason for the request, and a signature by an authorized agent on record. You can send your request by e-mail, fax, or mail.

 

The e-mail address is NCTracksprovider@nctracks.com. The fax number is 855-710-1965. The mailing address is:

 

CSRA

Provider EVC Unit

P. O. Box 300020

Raleigh, NC 27622-8020

 

The Enrollment department will notify the authorized individual by email or phone with a status of the request.

The provider may submit a Complete MCR to terminate all of their active health plans; doing this will terminate the provider record.

The steps are as follows:

Login to the NCTracks Provider Portal.

Click the Status and Management button and the Status and Management screen will display. The screen is divided into 6 sections: Submitted Applications, Saved Applications, Re-enroll, Manage Change Request, Re-verification and Maintain Eligibility.

To begin a new Manage Change Request, under the Manage Change Request Section, click the Radio button next to the NPI to be changed. Next, click the Update button.

Click the Next button until you reach the Health Benefit Plan Selection page.

On the Health Benefit Plan Selection page go to the Type of Update section.

Use the drop-down next to Update Type and Select Remove Health Benefit Plans.

Under each health plan you will select Yes to indicate that you would like to remove the active health plan.

Enter the date you choose to end each health plan.

Use the drop-down next to Reason for Ending Coverage. Select one of the following reasons:

Voluntary Termination - No longer meets criteria

Voluntary Termination - Closed or out of business

Voluntary Termination - No longer provides services

Provider is terminated due to change in ownership

Continue to click the Next button until you reach the Review Application page. Here you will be able to review your information for accuracy. Once completed, click Next.

On the Sign and Submit Electronic Application page, you will put in your Login ID (NCID), password, and your pin and click Submit Now to complete your Manage Change Request.

If the provider has no activity (claim submissions) on any of their active health plans for 12 consecutive months, they will be terminated in NCTracks and will have to re-enroll.

Yes, when a provider is terminated, the access to the NCTracks Provider Portal is not turned off. Provisioned users can still login and check status/history.

Out of State providers, including border-area providers, must be enrolled in Medicare or their home-state Medicaid program in order to enroll in NC Medicaid and Health Choice.  If Medicare participation cannot be verified, GDIT will contact the home-state Medicaid program for verification. If Medicare participation is required based on taxonomy, it will be verified, and home-state Medicaid participation will not be required.