In late March, NCDHHS held a 'Virtual Office Hours' event covering Provider Enrollment Hot Topics and Reminders.
The Practice Support team wanted to share some highlights from that event and the Q&A that followed:
1. Ensure the information in NC Tracks is accurate!
Medicaid and NC Health Choice participating providers are contractually required to update their record within 30 days of any change in the enrollment application.
Why is this important?
NC Tracks is the system of record for provider enrollment data which is then shared with the health plans.
Accurate information ensures that: beneficiaries can make the most informed choice when selecting their health plan and primary care provider; and billing providers can be paid for services rendered.
2. What if the information is not accurate or changes need to be made?
If provider / organization information is out of date or inaccurate (e.g., providers change affiliations), the Office Administrator (OA) should complete a 'Manage Change Request' (MCR) to correct it.
If the provider affiliation information is incorrect, the OA for the affiliated provider must update the group affiliation on the individual provider's record. Any information that is updated on an Organization or Individual NC Tracks Provider Record will be reflected in the provider directory after the NC Tracks MCR is complete.
If a provider name is listed incorrectly in NC Tracks, the course of action depends on the application type in process. For an Initial Enrollment Application, the provider must withdraw their application and submit a new application with their correct legal name. For a Re-enrollment, Manage Change Request (MCR) or re-verification application, the provider must upload a document supporting the name change (driver's license, social security card, marriage license or alternative government-issued proof of legal name) via the Upload Documents page and return the application. Once the application is submitted with the documentation supporting the name change, the NC Tracks enrollment specialist will withdraw the application to update the name within NC Tracks. Once the name change is completed, NC Tracks will notify the provider. The provider may then submit a new re-enrollment, MCR or re-verification application.
3. What about license expiration dates?
If your license is expiring, you must update it promptly in NC Tracks or your provider record may be suspended and/or terminated. A message will be posted to the Message Center Inbox on the secure provider portal 60 days prior to the expiration date. NC tracks receives weekly updates from the North Carolina Medical Board, but providers still need to validate the information.
4. Re-verification requirement to be re-instated:
Beginning in the Summer of 2022, providers will once again begin receiving re-verification notices. Providers are allowed 70 days to submit and avoid suspension. Providers who do not comply will be suspended. If a provider is still not in compliance 30 days following suspension they will be terminated. If a provider who is terminated wants to re-apply, a re-enrollment application must be submitted.
5. NC Medicaid and NC Health Choice application fee waived:
Effective January 9, 2022, pursuant to NC Senate Bill 105, Session Law 2021- 180 Section 9D.9(a), NC Tracks no longer requires Medicaid and NC Health Choice providers to pay the $100.00 fee with enrollment and re-verification applications.
Additional resources:
Slides from the Virtual Office Hours Hot Topics in Provider Enrollment
NC Tracks Provider User Guides and Training.
NC Tracks Fact Sheets / User Guides Provider Record Maintenance and Enrollment / Re-verification
