Outdated information on a provider’s NCTracks record can cause disruption in claims processing. Participating providers are contractually obligated to maintain their NCTracks provider record, which serves as the source of truth for managed care entities. It is vital for enrolled providers to use these resources, as well as the NCTracks Manage Change Request (MCR) process, to thoroughly and regularly review their individual and organization provider enrollment information and submit changes as needed.
As previously noted here, providers should pay particular attention to the following sections of the MCR, which commonly contain outdated information:
- Health Benefit Plan Selection: Confirm that the health plans in which participation is intended are selected (i.e. Medicaid, NC Health Choice).
- Service Location Address and Taxonomy Classification:
- Add all service locations intended to be displayed in the results of a search in the provider Look-up Tool. For example, add any missing affiliated organization address as a service location on the individual provider’s NCTracks record to ensure it displays in the Look-up Tool. When entering the service location, match the address character for character, so both the individual and organization’s address is the exactly the same.
- 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 and other Special Needs indicators are 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.
For assistance with completing an NCTracks Manage Change Request, 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