Provider Data Updates in NCTracks: Medicaid Managed Care

On Wednesday April 14th, 2021 NCDHHS posted Provider Data Updates highlighting the importance of ensuring provider data is correct in NCTracks. Please see important highlights below and click on the links for more complete information.

Highlights: Provider Data Updates:

NCTracks is the “system of record” for provider enrollment data, which is then shared with health plans to inform contracting and provider directories. 
If provider information is not current, then the data that flows forward to the health plans and the enrollment broker will not be accurate.
It is critical that all providers take the time now to review their provider records in NCTracks and submit changes as needed using the Manage Change Request (MCR) process.

What you need to look for and correct

One of the more common inaccuracies among individual provider data is the individual to organization affiliation. Many Medicaid and NC Health Choice provider records seemingly contain active former employer affiliations or an excessive number of affiliations; or have affiliation data that has not been updated in over a year. 

An analysis performed on March 31, 2021, shows that 61% of active Medicaid and/or NC Health Choice providers have affiliation data that has not been touched within the past year and it suggests that practices would benefit from a review of the accuracy of their data. 
Providers are encouraged to give special attention to individual to organization provider affiliations to ensure that it accurately reflects locations where an individual provider actively and routinely works.

To assist providers in the effort of securing accurate information, the Department generated interim provider enrollment record reports located on the Provider Playbook Trending Topics page. 

The Provider Affiliation Report (generated April 11, 2021) contains all active organizations, their service location and each affiliated individual provider. This report will only display individual to organization affiliations as found in NCTracks. 

If there are no such affiliations, no information will be displayed.

The information listed will also be used by the EB to populate their public-facing provider directory. 
Organizations should use the search function to find the practice and verify the accuracy of the affiliated providers for the location listed and identify any invalid affiliations.
Individual providers should use the search function to validate affiliation to both the organization and the organization location.

The Provider Directory Listing Report (generated April 11, 2021) contains all active Medicaid and NC Health Choice providers that will be published on the Enrollment Broker (EB) website in the Medicaid and NC Health Choice Provider and Plan Lookup Tool. This list includes Primary Care Providers (PCPs) and specialty providers who are contracted with a Health Plan and/or Tribal Option as well as providers who are not participating in managed care to reflect the NC Medicaid Direct provider population. 

The report also identifies practices slated to be included in the auto-assignment process due to their participation with the Advanced Medical Home program, and gives providers the opportunity to correct erroneous demographic and affiliation data on their enrollment record in the secure NCTracks Provider Portal.

Various forms of this message have been offered in Medicaid Provider Bulletins and Provider Playbook Fact Sheets.

Immediate Steps You Can Take To Ensure Accurate Data

1. Update Provider Record – If provider/organization information in the online directory is out-of-date or inaccurate, the provider's Office Administrator should complete a Manage Change Request (MCR) via the NCTracks Secure Provider Portal to correct it (inclusive of updates to demographic information, languages, and services).

If the individual to organization Provider Affiliation information is incorrect, the Office Administrator for the affiliated individual provider must update the group affiliation on the individual provider's record. 
Individual providers currently working at an organization that want their individual provider information to display as accepting the same health plans as their affiliated organization in the provider directory must not only have an active affiliation to the organization, they must also have the affiliated organization’s address listed as a service locations on their individual NCTracks record. If either the active affiliation or the organization’s service location address is missing from the individual provider record in NCTracks, the “Plans Accepted” displayed in the provider directory will not match.
Any information that is updated on an Organization or Individual NCTracks Provider Record will be reflected in the provider directory after the NCTracks MCR is complete.
If assistance is needed, providers may contact the NCTracks Call Center at 800-688-6696.

2. Review Contracting Status – Providers unable to find their practice associated with the correct Health Plans, should reach out directly to the Health Plan to correct the errors.

If contracting with health plans through a Clinically Integrated Network (CIN), providers may reach out to their CIN to resolve.
If issues persist, providers may contact the Medicaid Provider Ombudsman at Medicaid.ProviderOmbudsman@dhhs.nc.gov or 866-304-7062

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