Individual Provider Affiliation Requirement for Certain Organizational Providers is Forthcoming
Currently enrolled organizations with taxonomies identified will soon begin receiving notices to affiliate at least one active individual provider according to the guidelines first published here.
Beginning Nov. 21, 2021, NCTracks will identify organizational providers enrolled in taxonomies (provider type, classification, specialization) without the required affiliation of at least one active individual provider. Organizational providers 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.
Once implemented, this will become an ongoing requirement, obligating enrolled providers to maintain and update affiliations in order to avoid potential claims suspension and/or termination. Upon enrollment approval, new organizations will receive notices outlining the requirement with a deadline by which they must comply.
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
Enrolled NC Medicaid providers are contractually obligated to maintain their NCTracks provider record, which serves as the source of truth for managed care entities. Incorrect and/or outdated information on a provider’s NCTracks record can cause disruption in payment.
Providers must thoroughly and regularly review their individual and organization provider enrollment information as required and submit changes or corrections promptly.
For more information, please see Keep NCTracks Records Current to Avoid Claims Processing Issues.