Author: Provider Services
By July 1, 2018, Medicaid behavioral health providers added to NCTracks by their current Local Management Entity/Managed Care Organization (LME/MCO) Provider Upload Process must complete re-verification. On March 1, 2018, NCTracks sent letters to Behavioral Health providers due for reverification. Providers who did not respond by the reverification due date of April 16, 2018, had payment suspended. Providers must submit either a reverification application or a full Managed Change Request to NCTracks for the payment suspension to be lifted.
Per 42 CFR 438.608 (b), Provider Screening and Enrollment Requirements, the state, through its contracts with Managed Care Organizations (MCOs), Prepaid Inpatient Health Plans (PIHPs), Prepaid Ambulatory Health Plans (PAHPs), or Primary Care Case Management (PCCM) entities must ensure that all network providers are enrolled with the state as Medicaid providers, consistent with the disclosure, screening and enrollment requirements of 42 CFR 455, subpart B and subpart E.
Reverification of providers in NCTracks will generate the following requirements:
- A state-mandated application fee of $100. Additionally, the federal application fee of $569 may be charged to moderate- or high-risk provider as defined in N.C. General Statute Sec.108C-3, and the Provider Permission Matrix.
- Medicaid providers in moderate- and high-risk categories as defined by N.C. General Statute Sec.108C-3 are subject to site visits and required by 42 CFR 455 Subpart B. The site visits will be conducted by Public Consulting Group (PCG).
- Fingerprint-based background checks for all high categorical risk providers and any person with a 5 percent or more of direct or indirect ownership interest in the provider as a condition of enrollment in the North Carolina Medicaid Program, 42 CFR 455.434 and 42 CFR 455.450 (c).
Providers who fail to comply with the fingerprinting requirement are subject to a “for cause” denial or termination. A “for cause” action is one related to program compliance, fraud, integrity, or quality. North Carolina Medicaid is required to report providers terminated or denied for cause to CMS.
Providers who have already undergone fingerprint-based criminal background checks for Medicare or another state’s Medicaid or CHIP program are not required to submit new ones.
Providers with questions about this article can submit them to Medicaid.BehavioralHealth@dhhs.nc.gov.
Provider Services
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