Policy Clarification for Out-of-state Providers

Tuesday, December 4, 2018

Out-of-state providers, including border-area providers, must be enrolled in Medicare or their home-state Medicaid program to enroll in North Carolina Medicaid and NC Health Choice programs. If Medicare participation cannot be verified, NCTracks will contact the home-state Medicaid program for verification.

Required Medicare participation based on taxonomy will be verified, and home-state Medicaid participation will not be required.

To successfully administer screenings, application fees and revalidation requirements, as specified in the Code of Federal Regulations at 42 CFR 455.410, 42 CFR 455.414, 42 CFR 455.450 and 42 CFR 455.460, states must validate Medicare enrollment and, for out-of-state providers, proof of home state Medicaid participation. States can rely on the results of other states’ screenings, eliminating additional costs and burdens to state Medicaid programs and providers.

Although this is not a new policy, the Provider Permission Matrix will be updated to reflect this requirement. A Provider Enrollment FAQ has been posted.

NC Medicaid Provider Services, 919-855-4050