Author: NC Medicaid Provider Services, (919) 855-4050
This email is an update to yesterday’s email and previous North Carolina Medicaid Bulletins. In response to provider feedback, the use of the NPI Exemption List for residents and interns enrolled in graduate dental and medical programs, and area health education centers will be extended from January 31, 2018 to April 30, 2018.
Clinical pharmacist practitioners will continue to use the NPI Exemption List until further notice.
Residents and interns licensed through the N.C. Medical Board and N.C. Dental Board with a resident in training license (RTL) may enroll as ordering, prescribing and referring (OPR) lite providers via the abbreviated application in NCTracks. These practitioners will use the taxonomy 390200000X, Student Health Care, when enrolling as an OPR lite provider.
The services of residents or interns in a Graduate Medical Education teaching setting are not billable to Medicaid. Therefore, residents and interns who order services, prescribe medications or services, or make referrals must provide their NPI (if enrolled) or their supervising physician’s NPI to the provider submitting claims for service reimbursement. The supervising physician may bill for the services they personally provided during the patient encounter.
The following enrollment requirements will apply to OPR lite providers:
- $100 application fee
- Credentialing and criminal background checks including fingerprinting, if applicable
- Manage Change Request (MCR) submission to update or end date the provider record
- Revalidate every five years, and,
- MCR to change from an OPR lite enrollment provider to a fully enrolled provider if they meet the full enrollment criteria and are to be reimbursed for claims.
Note: OPR lite providers may request a retroactive effective date up to 365 days preceding the date of application.
NC Tracks Applications Processing Statistics for OPR Lite enrollment applications with the taxonomy 390200000X, Student Health Care (as of Jan. 22, 2018)
- Number of applications received - 2,691*
- Number of applications processed - 1,060.
- Average processing time for new applications – 25 days
*The total number of applications received increased by 1,004 since Jan. 5, 2018.