Ensure Your Information Displays Correctly in NC’s Provider Directory Tool – Provider & Health Plan Look-Up

Friday, September 25, 2020

As NC Medicaid moves forward with its planned implementation of Medicaid Managed Care, it is important for enrolled providers to act now to thoroughly review their individual and organization provider enrollment record in NCTracks. 

Not only is ensuring accuracy a requirement in the legal and binding NCDHHS Provider Administrative Participation Agreement, but correct information on the NCTracks provider record will assist beneficiaries with the search for primary care providers in the new NC Provider & Health Plan Look-Up, expected to be available Jan. 1, 2021. 

Every page of the NCTracks provider record should be assessed for accuracy. Providers should pay particular attention to the following sections, as the information will be used to search for individual and organization providers, and display results in the new NC Provider & Health Plan Look-Up directory.

  • Basic Information: Confirm the Office Administrator and accuracy of telephone and email contact information. 
  • Health Benefit Plan Selection: Confirm that the health plans in which participation is intended are selected (i.e. Medicaid, NC Health Choice).   
  • Addresses and Taxonomy Classification: Verify that each physical service location address meets USPS standards, is not duplicative of another service location, and that active taxonomies associated with each location are accurate. Select ‘Verify Address’ while in the Addresses section of the Manage Change Request to confirm that the address is found in the USPS database.
  • Accreditation: Update expiring licenses, certifications and accreditations.  
  • Hours of Operation: Confirm that the hours of availability to provide care are accurate.
  • Services: Ensure that the Physically Handicapped patients’ indicator is correct, as well as the Languages Supported in Office, Accepting New Patients, Accepting Siblings, and Gender and Age Served. 
  • Affiliated Provider Information: Confirm that individual providers are correctly affiliated to organizations billing on their behalf and to each appropriate location within that organization. This is not only vital for claims adjudication, it is essential to ensuring that complete and accurate information will display in the NC Provider & Health Plan Look-Up. When a beneficiary searches for an individual doctor at a specific organization’s location, the affiliated information from NCTracks is used in the search. Therefore, all individual providers should check their affiliations not only to the group NPI, but also to the specific location(s) where services are rendered.

Providers are encouraged to begin the Manage Change Request process to make necessary corrections and updates. For assistance, providers should reference the NCTracks Provider User Guides and Training tools located at: https://www.nctracks.nc.gov/content/public/providers/provider-user-guides-and-training/fact-sheets.html

Details about the design of North Carolina’s implementation of Medicaid Managed Care are available at: https://medicaid.ncdhhs.gov/transformation

Contact

GDIT, 1-800-688-6696