Policy Clarification for Out-of-state Providers

Friday, February 1, 2019

This article is an update to the article previously published in the December 2018 Medicaid Bulletin.

Out-of-state providers, including border-area providers, must be enrolled in Medicare or their home-state Medicaid program to enroll in NC Medicaid and 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.

This is not a new policy. Please refer to Provider Enrollment Frequently Asked Questions for additional information.

Author: 
NC Medicaid Provider Services, 919-855-4050