NCDHHS Awards Contract for Provider Data Management/Credentialing Verification Organization

Optum has been awarded a contract to implement the solution, scheduled to launch in 2024.

The North Carolina Department of Health and Human Services has awarded a contract to Optum to implement a new Provider Data Management/Credentialing Verification Organization (PDM/CVO) solution, scheduled to launch in 2024.Optum was selected after careful evaluation of the National Association of State Procurement Officials (NASPO) ValuePoint Contractors that responded to the state’s request for proposal. 

The new PDM/CVO solution will coordinate enrollment, credentialing, and ongoing provider data maintenance as a multipayer system and applies to providers in all NCDHHS programs: Division of Health Benefits (NC Medicaid), Division of Mental Health (DMH), Division of Public Health (DPH) and Office of Rural Health (ORH). NCDHHS is committed to ensuring providers can continue to operate their business with minimal interruption during the transition to the new PDM/CVO.

As the PDM/CVO vendor, Optum will work closely with NCDHHS to ensure that the PDM/CVO solution will:

  • Align North Carolina’s provider enrollment and credentialing standards with the National Committee for Quality Assurance (NCQA) and the Centers for Medicare & Medicaid Services (CMS) Standards and Conditions
  • Improve multipayer services and the provider experience under a centralized credentialing process.
  • Offers enhanced security protocols, an interactive enrollment process collecting data using common accreditation standards and allows delegation within the organization for multiple users to complete an application. 
  • Improves the provider notification process to streamline collaboration and effectively maintain provider data.

Attention Providers

While all providers must undergo enrollment and credentialing to deliver services for any NCDHHS program, existing records for those actively participating when the PDM/CVO launches will be loaded into the new system. Revalidation will occur according to the current schedule.

NCDHHS will support providers in the transition from the current enrollment process with education and outreach through webinars, stakeholder meetings, training workshops and communication bulletins, offering ongoing opportunities for providers to share feedback as the solution develops.

In preparation for the transition to the new PDM/CVO, providers are encouraged to:

  • Maintain an accurate provider record. Reviewing each provider record and correcting outdated information is essential to ensure information from the NCTracks provider record transfers to the new system accurately.
  • Stay informed. Review the NC Medicaid Provider webpage often and read all new Medicaid bulletins.
  • Participate in educational opportunities. Respond to opportunities to learn more about the PDM/CVO, including participating in webinars and other events, to be fully prepared for the new system.

For additional information, please visit the NC Medicaid Provider Data Management / Credentialing Verification Organization webpage

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