Author: NCTracks Call Center, 1-800-688-6696
NC Medicaid first alerted providers of changes to the recredentialing process in the February 2018 and August 2018 Medicaid Bulletins.
The terms recredentialing, reverification and revalidation are synonymous.
In April 2018, the recredentialing notification and suspension process was modified. The previous rule to extend the recredentialing due date if a Manage Change Request (MCR) Application is "In Review" has been removed. Therefore, if a change is required via an MCR, the MCR process must be completed before the recredentialing due date.
Providers will be suspended if the recredentialing application is not submitted by their recredentialing due date. Provider will be terminated from the North Carolina Medicaid and NC Health Choice programs following 50 days of suspension.
A list of providers scheduled for recredentialing in 2018 is available on the Provider Enrollment page of the NC Medicaid website under the "Recredentialing" header. Providers can use this resource to determine their recredentialing/revalidation due date and the month to begin the recredentialing process. Organizations and systems with multiple providers may download this list, which includes National Provider Identifier (NPI) numbers and provider names, to compare with their provider list.
Recredentialing is not optional. It is crucial that all providers who receive a notice promptly respond and begin the process. Providers are required to pay the $100 application fee for recredentialing. 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.