NC Provider Directory – Medicaid and NC Health Choice Provider and Health Plan Look Up Tool Now Available

Monday, January 25, 2021

The public version of the Medicaid and NC Health Choice Provider and Health Plan Lookup Tool is now available at: https://ncmedicaidplans.gov/. Providers are encouraged to use this tool to confirm the availability and accuracy of information contained in their NCTracks provider enrollment record.

The provider directory contains all active Medicaid and NC Health Choice providers, including primary care providers, specialists, hospitals and organizations. The authenticated portal will be available to beneficiaries beginning March 1, 2021. 

  • Provider information displayed in the online directory is sourced from the NCTracks provider records and supplemented with health plan contract data. 
  • Data displayed in the tool will be refreshed daily, at midnight, to reflect completed changes from the previous day. 
  • Any information that is updated on an Organization or Individual NCTracks Provider Record will be reflected in the provider directory after the NCTracks “Managed Change Request” is processed.

With over 90,000 providers participating in NC Medicaid, the available search options offer instructions about fields required to conduct a search and are designed to narrow search results to a level manageable to find the desired provider. Depending on the search conducted, the results are expected to display the following applicable information for individual and/or organization providers: 

Provider’s Last Name (or Organization name) Languages Supported
Provider Gender (individual providers only) Wheelchair Accessibility
NPI/Atypical Number Accepting New Patients
Service Location address/phone number Accepting Siblings
Hours of Operation Accepting Female Age Group
Benefit Program (available March 1, 2021) Accepting Male Age Group
Health Plans Accepted Provider’s Specialty (based on Taxonomy description)

For organizations, the results will also display a list of individual affiliated providers and include the specialties of those affiliated providers in the Provider’s Specialty information. There are four search capabilities: 

  1. Search by health plan for a Provider, 
  2. Search by health plan for an Organization, 
  3. Search by Provider for a health plan, and
  4. Search by Organization for a health plan. 

There is an advanced search option to filter results based on several criterion, including Provider or Organization specialty and sub-specialty (based on taxonomy).  

Important to note:

  • Internet Explorer (IE) is not fully supported and may not yield expected results. Please use Google Chrome, Mozilla Firefox, Apple Safari, or Microsoft Edge for the ability to fully access and navigate the Tool.
  • The “Search by health plan for a Provider” and “Search by Provider for a Plan” options display information from the individual NCTracks provider record only. The affiliated organizational information does not display in these results, including health plan contract affiliation that may be assigned to the affiliated organization but not captured for the individual. 
  • Searching by provider in the current tool does not display information about the individual provider’s affiliated organizations. 
  • The “Search by health plan for an Organization” and “Search by Organization for a Plan” options require the user to enter the name according to the legal organization name on the NCTracks record. A search by a Doing Business As (DBA) name or Service Location name may not yield expected results. In addition, the user must begin with the first word of the name. For example, if the legal name begins with “The” or “A”, the name entered must begin the same. Note: Beginning March 1, 2021, results will display when any part of the Legal, DBA, or Service Location name is used.
  • All active service locations will be displayed in the tool and offer a button to “Enroll’” however, through an authentication process, only PCP/AMH-designated providers will actually be selectable by Medicaid and NC Health Choice beneficiaries. 

It is the responsibility of the provider or organization to contract with health plans for locations where services are rendered. 

Additional information can be found on the Get Answers page, located at: https://ncmedicaidplans.gov/learn/get-answers. Although providers can report suspected errors by navigating to the “Report an Error” link on the top right corner of the tool, there are more focused avenues that will expedite changes:

  • Changes to the information displayed in the results (I.e. name, address, languages) must be reported using the Manage Change Request process in NCTracks for that provider record. Contact the NCTracks Call Center at 800-688-6696 for assistance with that process
  • The Managed Care contracts a provider has with a health plan(s) are displayed under “health plans accepted.” See Health Plan Contacts and Resources if changes to this affiliation need to be made. 

Providers are encouraged to utilize the tool to ensure their information is available and displays as expected. 

Contact

NCTracks Call Center: 800-688-6696