Author: Provider Services
Effective July 1, 2018, North Carolina Medicaid and NC Health Choice (NCHC) behavioral health providers who were added to NCTracks via the Local Management Entity/Managed Care Organization (LME/MCO) Provider Upload process must complete reverification. Medicaid identified 474 behavioral health providers as needing to complete reverification. Providers identified are being notified of their reverification due date via NCTracks communication to the Office Administrator (OA) on record.
Providers who do not respond by the July 1, 2018 reverification due date will be subject to claims payment suspension. Providers must submit either a reverification application or a full Managed Change Request (MCR) to NCTracks for a claims payment suspension to be removed.
Note: A list of providers scheduled for reverification is available on Medicaid’s provider enrollment web page under the “Re-credentialing” header.
Pursuant to 42 CFR 438.608 (b), Provider screening and enrollment requirements, the state, through its contracts with a Managed Care Organization (MCO), Prepaid Inpatient Health Plan (PIHP), Prepaid Ambulatory Health Plan (PAHP), Primary Care Case Management (PCCM), or PCCM entity 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, subparts B and subpart E.
Reverification of Behavioral Health 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 108C-3, and the Provider Permission Matrix.
- Medicaid providers in moderate-and high -risk categories as defined by N.C. General Statute 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 direct or indirect ownership interest in the provider as a condition of enrollment in the NC Medicaid Program, Federal Regulation 42 CFR 455.434 and 42 CFR 455.450 (c).
For more information on the Fingerprint process, refer to the articles titled, Fingerprinting Process for Providers or Submit Fingerprinting Criminal Background Check and Related Information by Deadline to Prevent Termination in the June 2018 Medicaid Bulletin , or the Frequently Asked Questions (FAQs) posted on NCTracks.
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.
Providers with questions about this article can submit them to Medicaid.BehavioralHealth@dhhs.nc.gov.
Provider Services
DMA, 919-855-4050