Currently, providers may use the National Provider Identifier (NPI) of the beneficiaries’ CCNC/CA provider on the claim. However, CCNC/CA providers have the option to enter managed care referrals directly into NCTracks, and are encouraged to become familiar with this process. As announced in a June 2016 Medicaid Special Bulletin, effective Nov. 1, 2016 NCTracks will deny a claim when an NPI is not submitted for the ordering provider, referring provider, operating provider, or service facility.
Editing must also be implemented to ensure that the ordering provider or the referring provider is an individual; claims should not be paid if the ordering provider or the referring provider is identified in the system as an organization. Beginning with dates of service Nov. 1, 2016, CCNC/CA referrals must be entered directly into NCTracks. Providers will no longer submit the beneficiary’s PCP organization NPI on the claim for CCNC/CA referrals.
Providers should begin provisioning their staff that may use this function in NCTracks. For more information on entering managed care referrals in NCTracks, see Section 220.127.116.11 “Managed Care Referrals: Submission” in the Provider Claims and Billing Assistance Guide or Section 5.0 the NCMMIS Prior Approvals: Medical (Providers) Participant User Guide in SkillPort.
NCTracks Provider Enrollment provides the online application and a checklist for provider qualifications and requirements.
- Providers must provide services only after they are enrolled as an NC Medicaid or NC Health Choice (NCHC) provider.
- Providers must submit their applications with a valid email address.
- Application receipts will be acknowledged by email or by mail.
- The Division of Medical Assistance fiscal agent, CSC, will communicate by email if missing or additional information is needed from providers.
DMA will consider specific requests for retroactive effective dates if:
- A customer has been granted retroactive eligibility
- An emergency service was provided
- 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
DMA 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.
Providers are required to recredential every five years, using the online process in NCTracks, to continue Medicaid program participation. You will receive a notice posted to your NCTracks Message Center Inbox 45 days in advance of your recredentialing deadline.
Providers who do not complete the recredentialing process on time will be suspended from Medicaid program participation. If recredentialing is not completed within 30 days after the notification, participation will be terminated.
North Carolina law requires that providers pay a $100 fee for Medicaid recredentialing.
Note that recredentialing does not apply to time-limited enrolled providers, such as out-of-state providers. Out-of-state providers must complete the enrollment process every 365 days.
Out-of-State Provider Enrollment
Out-of-state providers are required to adhere to all North Carolina rules, regulations, laws and statutes governing healthcare delivery under the N.C. Medicaid and the N.C. Health Choice (NCHC) programs. They are only eligible for time-limited enrollment under the following conditions:
- For the reimbursement of services rendered to N.C. Medicaid or NCHC beneficiaries in response to emergencies or if travel back to North Carolina would endanger the health of the eligible beneficiaries
- For reimbursement of a prior-approved non-emergency service, or,
- For reimbursement of medical equipment and devices that are not available through an enrolled provider located within North Carolina or in the 40-mile border area.
Out-of-state providers must submit a re-enrollment application every 365 days in order to continue as N.C. Medicaid or NCHC providers.
Out-of-state providers must wait until the day after their current enrollment period ends – when their provider record is terminated – to begin the re-enrollment process. Many out-of-state providers are attempting to re-enroll using a Managed Change Request (MCR) prior to the end of their current enrollment period. This will not continue provider enrollment. MCRs are used to report changes to the provider record; they do not serve as re-enrollment applications.
Providers with questions about the NCTracks online enrollment application can contact the CSC Call Center at 1-800-688-6696 (phone); 919-851-4014 (fax) or NCTracksprovider@nctracks.com (email).