Maintain Provider Eligibility Process

As announced over the last several months in the Medicaid Bulletin, effective October 29, 2017, the North Carolina Department of Health and Human Services (DHHS) will implement in NCTracks a quarterly Maintain Eligibility Process. This process identifies enrolled providers with no claim activity within the past 12 months. NCTracks will notify the provider by a Notification of Inactivity Letter posted to the secure provider portal mailbox. The provider must attest electronically to remain active. Please note that:

• Providers who have a Manage Change Request in review or a re-verification application submitted within the past year will not receive a letter for the quarter.
• Rural Health Clinics and Federally Qualified Health Centers are excluded from this requirement.

The Maintain Eligibility Process reviews NCTracks history to see if the provider has been any of the following providers on any claims over the last 12 months:

• Billing
• Rendering
• Attending
• Ordering
• Referring
• Service facility
• Prescribing
• Operating
• Other operating

When a provider is identified as 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. The Notification of Inactivity Letter provides guidance for completing the Maintain Eligibility Application on the secure NCTracks provider portal. 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 North Carolina Medicaid and NC Health Choice (NCHC) programs will be end dated and a Provider Termination Letter will be sent by certified mail. The Maintain Eligibility Process will help prevent fraud, waste and abuse in the Medicaid and NCHC programs.