Individual Provider Affiliation to be Required for Certain Organizational Providers
Beginning Nov. 21, 2021, organizational providers with taxonomies identified 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. NCTracks will identify organizational providers enrolled in taxonomies (provider type, classification, specialization) without the required affiliation of at least one active individual provider.
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.
- This modification will verify providers meet the enrollment criteria for each taxonomy and support 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.
For more information, please see Organizational Provider Records Without the Required Individual Provider Affiliation Risk Suspension/Termination.
Keep NCTracks Records Current to Avoid Claims Processing Issues
Outdated information on a provider’s NCTracks record can cause disruption in claims processing.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.
For more information, please see Keep NCTracks Records Current to Avoid Claims Processing Issues.