Organizational Provider Records Without the Required Individual Provider Affiliation Risk Suspension/Termination
Forthcoming modifications to NCTracks will allow the system to identify organizational providers enrolled in taxonomies (provider type, classification, specialization) without the required affiliation of at least one active individual provider.
Beginning Nov. 21, 2021, organizational providers with the taxonomies identified in the chart below are required to have at least one active affiliated individual provider with at least one active taxonomy related to their credentialed status as a taxonomy level 1 provider.
- This modification will verify providers meet the enrollment criteria for each taxonomy and supports efforts to keep provider enrollment files current.
- Once implemented, this will become an ongoing requirement, obligating providers to maintain and update affiliations in order to avoid potential claims suspension and/or provider enrollment termination.
| Community/Behavioral Health (251S00000X) | Organization must have: At least one active affiliated provider who is enrolled in at least one level 1 behavioral health and social service provider taxonomy |
| Multi-Specialty (193200000X) | Organization must have:
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| Single Specialty (193400000X) | Organization must have: At least one active taxonomy related to their credentialed status as a taxonomy level 1 description (as listed under Multi-Specialty) |
| Primary Care (261QP2300X) | Organization must have: At least one active affiliated provider with a taxonomy related to their credentialed status as a Doctor of Medicine (MD), Doctor of Osteopathic Medicine (DO), Nurse Practitioners (NP), Physician Assistant (PA), or Certified Nurse Midwife (CNM). |
For more information regarding taxonomy levels, providers should refer to the NCTracks Provider Permission Matrix.
Currently enrolled organizations with no affiliated individual providers will receive notices which include a deadline to affiliate at least one active individual provider according to the guidelines above.
Newly enrolling organizations must be approved prior to affiliating individual providers. Upon approval, new organizations will receive notices which include a deadline to affiliate at least one active individual provider according to the guidelines above. Providers initially have 90 days to meet this requirement.
Providers who do not meet the deadline will be issued a Suspension Notice, advising that claims for the affected taxonomy will pend until the required affiliation update is made. The notice includes a 30-day deadline by which the update must be made in order to avoid termination of the applicable taxonomy. If the affected taxonomy is the only taxonomy of record, the service location and/or provider record may also be terminated.
To affiliate an individual provider to an organization, providers should submit a Manage Change Request under the individual provider’s NPI. The Office Administrator for the individual provider record should follow these steps to complete the Manage Change Request application:
- Log in to the NCTracks Secure Provider Portal
- Navigate to the Status and Management page
- The NPI will be located in the Manage Change Request section
- Select the individual NPI and click Update
- Complete and submit the Manage Change Request application
Note: An abbreviated Add/Update Affiliations Manage Change Request Type is available if the affiliation is the only updated needed. Guidance is available in the user guide “How to Submit a Manage Change Request adding a Service Location and Affiliate an Individual Provider Record to a Group/Organization in NCTracks.”
Contact
NCTracks Call Center at 800-688-6696 or NCTracksprovider@nctracks.com.
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