New Information Required in Applications for Individual Providers Enrolling in Medicaid and NC Health Choice

Monday, June 8, 2020

Effective July 26, 2020, changes will be made to initial enrollment, re-enrollment, re-verification applications and manage change requests (MCRs) for individual providers (excluding disaster relief and Out of State Lite providers). The updates include the addition of a new page, as well as additional exclusion sanction questions. 

NCTracks is collecting this additional information to assist in streamlining the data collection process for providers and Prepaid Health Plans (PHPs) to facilitate network eligibility determinations.

New information required for individual providers includes:

  • Highest level of education
  • Malpractice insurance (coverage type and amount)
  • Healthcare-related work history (past five years, and if there is more than six-month gap, explanation of gap)
  • Malpractice settlement history (past five years)
  • Any conditions that might impact ability to perform job duties 

Additionally, individual providers completing the application will be required to physically sign and upload an Individual Agreement themselves- the office administrator (OA) cannot complete this for them. This will be accessible through two locations within the provider record, the Final Steps page and the Upload Documents page. 

If insufficient information is provided by the individual or in NCTracks background verification, a request for supporting documentation will be sent to the provider. The Upload Documents page also allows the provider to upload any supporting documentation necessary.  

Providers currently enrolled do not need not take any action. However, providers will be required to supply the new information at re-verification. In addition, certifications and accreditations can be added at any time using the MCR process.  

Please note that due to the system changes, any enrollment, re-enrollment and re-verification applications that are in draft will be deleted on July 26, 2020, to allow for updates to the application process. Providers are encouraged to submit their drafts prior to this date or wait to begin their application until after implementation if their application deadline allows.

Information on upcoming training opportunities and resources (such as webinars, job aids, etc.) regarding these changes will be posted on the NCTracks website and communicated through email updates when available. Further information will be provided closer to the implementation date. 

To subscribe to NCTracks emails, click on the link under the heading “Sign Up for NCTracks Communications” on the NCTracks Provider Communications page or text NCTRACKS to 22828 and follow the prompts.

Contact

NCTracks Contact Center: 800-688-6696