Medicaid Required Enrollment Fees - UPDATED
Author: Provider Services, DMA, 919-855-4050
The N.C. Medicaid and N.C. Health Choice (NCHC) application fee is $100, which covers costs associated with processing enrollment applications. The $100 application fee is required for both in-state and border-area (within 40 miles) providers during initial enrollment and when providers complete the five-year reverification process.
If an out-of-state provider chooses to enroll using the full-enrollment application, the $100 fee will apply. Out-of-state (OOS) providers using the lite-enrollment application have the option to change from lite to full enrollment by submitting a Manage Change Request (MCR). In that case, they also will also be required to pay the $100 application fee.
If the application is abandoned, withdrawn, or denied, the provider will be required to pay the application fee a second time upon resubmission of the application.
In addition, some providers are required to pay the Affordable Care Act (ACA) application fee. These providers are defined in federal regulation at 42 CFR 455.460, and in N.C. General Statute 108C-3 (e) and (g) as moderate- or high-risk. The ACA application fee is $569 for calendar year 2018, and may be adjusted by the Centers for Medicare and Medicaid Services (CMS) annually. This fee covers the costs associated with provider screening during the enrollment process. The application fee will be collected during initial enrollment, adding a new site location, reenrollment, and five-year reverification.
Currently, the fee collection is a manual process for CSRA. On Jan. 28, 2018, system modifications in NCTracks will be made to automate the fee collection for a more efficient processing time for enrollment, reenrollment, MCR and reverification applications. Because of the changes, all enrollment, reenrollment, MCR and reverification applications currently in “saved draft” status will be deleted on Jan. 28, 2018. To prevent these applications from being deleted, the draft must be submitted. Applications created on or after Jan. 29, 2018, can once again be saved to draft.
Providers are encouraged to review the Status and Management page on the secure NCTracks Provider Portal for applications that have been initiated by the Enrollment Specialist (ES) or Office Administrator (OA), but not completed. When there is a saved draft application providers will see “N/A” under the “Select” column of the Records Results.
|
APPLICATION TYPE |
NC FEE $100 |
ACA FEE |
ACA SITE VISIT |
ACA TRAINING |
|
Enrollment |
Always required when provider applied for Medicaid and/or NCHC
Exclusion: OOS Lite |
ACA fee is required per location when one or more ACA taxonomy codes (as identified on the Permission Matrix) are added.
Note: Medicaid/NCHC plans only |
ACA site visit is required per location when one or more ACA taxonomy codes (as identified on the Permission Matrix) are added.
Note: Medicaid/NCHC plans only |
Always required when provider applied for Medicaid and/or NCHC |
|
Reenrollment |
Never required |
ACA fee is required per location when one or more ACA taxonomy codes (as identified on the Permission Matrix) are added.
Note: Medicaid/NCHC plans only |
ACA site visit is required per location when one or more ACA taxonomy codes (as identified on the Permission Matrix) are added.
Note: Medicaid/NCHC plans only |
Never required |
|
Manage Change Request |
Only required when an OOS lite provider upgrades to OOS full provider |
ACA fee is required per newly added/reinstated location when one or more ACA taxonomy codes (as identified on the Permission Matrix) are added.
Note: Medicaid/NCHC plans only |
ACA site visit is required per newly added/reinstated location when one or more ACA taxonomy codes (as identified on the Permission Matrix) are added.
Note: Medicaid/NCHC plans only |
Never required |
|
Reverification |
Always required when provider is active in Medicaid and/or NCHC |
ACA fee is required per location when one or more ACA taxonomy codes (as identified on the Permission Matrix) are active. Note: Medicaid/NCHC plans only |
ACA site visit is required per location when one or more ACA taxonomy codes (as identified on the Permission Matrix) are active. Note: Medicaid/NCHC plans only |
Never required |
|
Abbreviated MCR |
Never required |
Never required |
Never required |
Never required |
|
Change Office Administrator |
Never required |
Never required |
Never required |
Never required |
|
Maintain Eligibility |
Never required |
Never required |
Never required |
Never required |
|
Fingerprinting |
Never required |
Never required |
Never required |
Never required |
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