Provider Data Updates

<p>Providing the most accurate and complete provider information is a top priority so Medicaid and NC Health Choice beneficiaries can make the most informed choice for their health plan and primary care provider.&nbsp;</p>

Please note this bulletin was updated on June 17, 2021, to add the new phone number for the Provider Ombudsman.

Providing the most accurate and complete provider information is a top priority so Medicaid and NC Health Choice beneficiaries can make the most informed choice for their health plan and primary care provider. NCTracks is the “system of record” for provider enrollment data, which is then shared with health plans to inform contracting and provider directories. 

In our review, the primary challenge with accurate data has been encouraging providers to keep their information accurate and current on all applicable enrollment records. If provider information is not current, then the data that flows forward to the health plans and the enrollment broker will not be accurate.

Over the past several months, NCDHHS has issued reminders for providers to review their individual and organization provider enrollment record in NCTracks. It is critical that all providers take the time now to review their provider records in NCTracks and submit changes as needed using the Manage Change Request (MCR) process.

One of the more common inaccuracies among individual provider data is the individual to organization affiliation. Many Medicaid and NC Health Choice provider records seemingly contain active former employer affiliations or an excessive number of affiliations; or have affiliation data that has not been updated in over a year. 

  • Although updates are only required if a provider experiences a change, an analysis performed on March 31, 2021, shows that 61% of active Medicaid and/or NC Health Choice providers have affiliation data that has not been touched within the past year and it suggests that practices would benefit from a review of the accuracy of their data. 
  • The Department understands that individual to organization provider affiliations impact the claim adjudication process; however, providers are encouraged to give special attention to this information to ensure that it accurately reflects locations where an individual provider actively and routinely works.

To assist providers in the effort of securing accurate information, the Department generated interim provider enrollment record reports located on the Provider Playbook Trending Topics page. 

Various forms of this message have been offered in Medicaid Provider Bulletins and Provider Playbook Fact Sheets.

  1. Update Provider Record – If provider/organization information in the online directory is out-of-date or inaccurate, the provider's Office Administrator should complete a Manage Change Request (MCR) via the NCTracks Secure Provider Portal to correct it (inclusive of updates to demographic information, languages, and services).
    • If the individual to organization Provider Affiliation information is incorrect, the Office Administrator for the affiliated individual provider must update the group affiliation on the individual provider's record. 
    • Individual providers currently working at an organization that wants their individual provider information to display as accepting the same health plans as their affiliated organization in the provider directory must not only have an active affiliation to the organization, they must also have the affiliated organization’s address listed as a service location on their individual NCTracks record. If either the active affiliation or the organization’s service location address is missing from the individual provider record in NCTracks, the “Plans Accepted” displayed in the provider directory will not match.
    • Any information that is updated on an Organization or Individual NCTracks Provider Record will be reflected in the provider directory after the NCTracks MCR is complete.
    • If assistance is needed, providers may contact the NCTracks Call Center at 800-688-6696.
  2. Review Contracting Status – Providers unable to find their practice associated with the correct Health Plans, should reach out directly to the Health Plan to correct the errors.
    • If contracting with health plans through a Clinically Integrated Network (CIN), providers may reach out to their CIN to resolve.
    • If issues persist, providers may contact the Medicaid Provider Ombudsman at Medicaid.ProviderOmbudsman@dhhs.nc.gov or 866-304-7062

Resources

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