Re-credentialing and Ongoing Verification Updates - May 10, 2018

List of Providers Due for Re-credentialing

A list of providers scheduled for re-credentialing in 2018 is available on the provider enrollment page of the North Carolina Medicaid website under the “Re-credentialing” header. Providers can use this resource to determine their re-credentialing/re-validation due date and determine which month to begin the re-credentialing process. Organizations and systems with multiple providers may download this spreadsheet, which includes National Provider Identifier (NPI) numbers and provider names, to compare with their provider list.

Note: The terms re-credentialing, re-verification, and re-validation are synonymous.

Changes to Re-credentialing Process

Beginning April 30, 2018, the re-credentialing notification and suspension will be modified to the following:

1. The notification, suspension, and termination timeline will be modified to the following:

• • First notification will now be sent 70 days prior to the provider re-credentialing due date.
  • If re-credentialing is not submitted, reminders will be sent at 50 days, 20 days, and 5 days prior to the provider re-credentialing due date.
  • Providers will be suspended if the re-credentialing application is not submitted by their re-credentialing due date.
  • The provider will be terminated from the North Carolina Medicaid and NC Health Choice programs at the end of the month following 50 days of suspension.

2. Re-credentialing is not optional. It is crucial that all providers who receive a notice promptly respond and begin the process.
3. Providers are required to pay a $100 application fee for re-credentialing.
4. The existing rules to extend the re-credentialing due date if a Manage Change Request (MCR) Application is “In Review” will be removed. Therefore, if a change is required via a MCR, the MCR process must be completed before the re-credentialing due date.
5. The Re-credentialing Application on the NCTracks Provider Portal will be modified to display the existing owners and managing employees and allow the provider to edit, end-date, or add to the Re-credentialing Application.

Note: Providers must thoroughly review their electronic record in NCTracks to ensure all information is accurate and up-to-date and take any actions necessary for corrections and updates.

If terminated, the provider must submit a re-enrollment application to be reinstated.

Re-credentialing does not apply to time-limited enrolled providers, such as out-of-state (OOS) lite providers. OOS providers who enroll using the OOS-lite application must complete the enrollment process every 365 days. OOS providers who are fully enrolled must re-credential every five years.

Because of the system changes, all enrollment, re-enrollment, MCR and re-verification applications currently in “saved draft” status were deleted on April 28, 2018. Applications created on or after April 29, 2018, can once again be saved to draft.

Changes to Ongoing Verification Process

Providers must also update their expiring licenses, certifications and accreditations. The system currently suspends and terminates providers who fail to respond within the specified time limits.

With system modifications, the notification, suspension, and termination timeline will be modified to the following:

1. First notification will be sent 60 days prior to expiration
2. If the expired item has not been updated, a reminder will be sent on days 30, 14, and the final reminder on day 7 prior to expiration
3. The provider will be suspended if the expired item has not been updated by the due date. The suspension will remain for 60 days, and can be removed at any time if the expired item is updated.
4. The provider’s participation in the North Carolina Medicaid and NC Health Choice programs will be terminated if the item has not been updated by day 61 after suspension.

Providers with questions about the re-credentialing process can contact the NCTracks Call Center at 1-800-688-6696 (phone), 919-710-1965 (fax) or NCTracksprovider@nctracks.com.