In September 2015, Session Law 2015-245 directed the North Carolina Department of Health and Human Services (NCDHHS) to transition Medicaid to a managed care structure. This federally approved change imposed additional administrative burdens and program complexity to North Carolina Medicaid enrolled providers.
NCDHHS seeks to support its providers by replacing the current provider enrollment and data management system components of NCTracks with a centralized Provider Data Management / Credentialing Verification Organization (PDM/CVO) solution.
The new PDM/CVO is a timesaving, cost-effective, and scalable solution that consolidates provider data management and furnishes a centralized solution to coordinate enrollment, credentialing and ongoing data maintenance among the payers as a multi-payer system.
The PDM component will have the capability to manage data intake and maintenance throughout the provider lifecycle, and the CVO component will perform credentialing on behalf of NCDHHS. In addition, this solution will:
- Improve user experience by eliminating redundant data entry across multiple plans, simplifying registration for multi-payer providers, enhancing security controls, and providing real-time assistance.
- Address NC Medicaid program needs by reducing provider administrative burden in NC Medicaid Managed Care and NC Medicaid Direct and upgrading data architecture and modularity.
- Align with Centers for Medicare & Medicaid Services (CMS) Standards and Conditions to support seamless coordination, integration, and interoperability.
PDM/CVO will be operational in early-2024.
- During this transition, providers will experience a seamless managed care enrollment and credentialing process with no beneficiary service or provider payment delays.
- In addition to all provider enrollment activities taking place using the new PDM/CVO platform, existing data in each provider enrollment record will be converted and loaded into the new system.
- Current re-credentialing deadlines will remain unchanged.
During the new centralized credentialing process rollout, provider communities are encouraged to remain informed through webinars, stakeholder meetings, and training workshops, as well as to maintain an accurate provider record.
For the most up to date provider information, please visit the NC Medicaid Provider webpage.