Update - Avoid Delays in the Processing of Provider Enrollment Applications

Note: This article was previously published in the February 2018 Medicaid Bulletin with additional information.

If a provider’s enrollment application or Manage Change Request (MCR) does not contain errors, it will process more quickly. The NCTracks Enrollment Team identified commons errors that cause delays in processing applications and MCRs. Common errors include:

• Supporting documentation not attached – If supporting documentation is required, it must be uploaded and attached prior to submission (including license/certification/accreditation). For guidance on how to attach supporting documentation, refer to section 3.30.1 of Participant User Guide PRV111 Provider Web Portal Applications on the secure NCTracks Provider Portal.
• Name on application – Name on application should match National Plan and Provider Enumeration System (NPPES) National Provider Identifier (NPI).
• Office Administrator (OA) – Make sure that the OA on record is current. Important notices are sent to the attention of the OA on the provider’s record. For more information, see OA Change Process on NCTracks.
• Incomplete Exclusion Sanction information – The Exclusion Sanction questions must be answered. On question K, all convictions (misdemeanors and felonies) must be disclosed regardless of how old the conviction is. (The only exception to this requirement is minor traffic offenses, such as a speeding ticket, expired registration, etc.)  The questions must be answered for the enrolling provider and the practice’s owners and agents in accordance with 42 CFR 455.100; 101; 104; 106 and 42 CFR 1002.3.
• If the answer to any of the Exclusion Sanction questions is “yes,” then documentation regarding the disposition of the action must be attached to the application. If a provider submits a written attestation, it must be on company letterhead and signed and dated by the person to whom the attestation applies. For a complete list of questions, go to the Provider User Guides and Training page of the NCTracks Provider Portal and open either the How to Enroll in North Carolina Medicaid as an Individual Practitioner or How to Enroll in North Carolina Medicaid as an Organization user guides, both of which are located in the Enrollment and Re-Verification section. These documents contain the list of sanction questions.
• Managing Entity - NCTracks is often receiving provider enrollment applications with as many as 25 or more managing entities, which suggests that it may not be clear who should be listed as a managing entity on an application.
• The role of Managing Employee is defined in 42 CFR 420.201:
• “Managing employee means a general manager, business manager, administrator, director or other individual that exercises operational or managerial control over or who directly or indirectly conducts, the day-to-day operation of the institution, organization or agency, either under contract or through some other arrangement, whether or not the individual is a W-2 employee.”
• Providers are encouraged to only include those people who match the federal definition as a managing entity on their enrollment application.
• Including people who do not match the definition of a Managing Employee on an application is not just inaccurate, but adds unnecessary time and effort to the provider enrollment application process. Remember that every person listed as a managing entity on a provider enrollment application must undergo a background investigation.
• Providers can help expedite the review and approval of their enrollment applications by making sure that everyone listed as a managing entity matches the federal definition.
• Fingerprinting Evidence Release Form Scanning Issue - When some providers scan and upload the Fingerprinting Evidence Release Form, the embossed seal from the fingerprinting agency often does not scan clearly. Providers are advised to double-check that the seal clearly uploaded.
• Failure to upload Electronic Fingerprinting Submission Release of Information Form (Evidence) – The form must be signed and dated by each person required to submit fingerprints. It must also be signed and dated by the law enforcement agency collecting the fingerprints. Providers must upload the Release of Information Form into NCTracks by the deadline on the notification letter.
• Fingerprinting Card should not be mailed to address on the evidence form –  If the applicant opts to do a Fingerprint Card, it must be mailed to the State Bureau of Investigation (SBI) for processing at NCSBI/Applicant Unit, 3320 Garner Road, Raleigh, NC 27626.
• Choosing the incorrect taxonomy code – The taxonomy code selected must accurately reflect the type of provider. The provider must meet the enrollment qualifications for the taxonomy code selected and possess the required licensure and/or credentials. Providers who are uncertain which taxonomy code to select should consult the Provider Permission Matrix (and instruction sheet) on the Provider Enrollment page of the NCTracks Provider Portal. For additional guidance, refer to How to View and Update Taxonomy on the Provider Profile in NCTracks on the Provider User Guides and Training page of the NCTracks provider portal.
• NCID misuse – This continues to be an issue on applications and may result in adverse action on the provider’s application and record. Refer to the article, Using NCIDs Properly in NCTracks, in the December 2016 Medicaid Bulletin.
• Inaccurate entry of names, Social Security numbers (SSN) and date of birth (DOB) on applications – This continues to be an issue which impacts the integrity of the application and Participation Agreement and may result in adverse action on the application.

For assistance with NCID and/or PIN, refer to the Getting Started web page on NCTracks and the NCTracks NCID Fact Sheet.

Providers with questions can contact the CSRA Call Center at 1-800-688-6696 (phone), 1-855-710-1965 (fax) or NCTracksProvider@nctracks.com.

CSRA, 1-800-688-6696