Author: GDIT Call Center, (800) 688-6696
The Department recognizes that the move to managed care may impose additional administrative burdens and program complexity to the work NC providers already do. To mitigate the administrative burden on providers as NC Medicaid transitions to managed care, the Department procured a contractor to supplement the state’s existing provider enrollment data. This data will be combined with provider enrollment information NC Medicaid has on file to support the Prepaid Health Plans’ (PHPs’) ability to help determine which providers to contract with.
On Dec. 31, 2018, a contract was awarded to Wipro Infocrossing to serve as the Provider Data Contractor (PDC).
PHPs will rely upon the provider credentialing information to determine if a provider meets the PHP’s provider “quality standard” and therefore should be allowed to participate in the PHP’s provider network. The Department designed a streamlined process to facilitate providers enrolling with a PHP for the first time as well as providers currently participating in North Carolina Medicaid or NC Health Choice.
- The PDC will be responsible for obtaining the primary source-verified credentialing data for North Carolina Medicaid and NC Health Choice enrolled providers.
- Neither the PHPs nor the PDC will be permitted to reach out to providers to update the provider’s credentialing information, though providers are encouraged to keep their credentialing file up to date.
- To ensure that PHPs have access to information from a credentialing process that is held to consistent, current standards, the credentialing data is intended to be primary source-verified under the standards of NCQA.
It is important that providers take action now to update their enrollment records through the NCTracks provider portal.
Providers should:
- Review affiliations by location for accuracy
- End-date any affiliations that are not current
- Make sure physical addresses are correct with the accurate taxonomies
- Review license, certification, and accreditation information
- If necessary, begin the Managed Change Request process to make necessary corrections and updates.
For assistance, please reference the NCTracks Provider User Guides and Training, Provider Record Maintenance.
Detailed information about the design of North Carolina’s implementation of Medicaid Managed Care is available at https://medicaid.ncdhhs.gov/transformation