Provider Reverification
Providers for whom recredentialing/reverification was delayed are being notified of their requirement to complete the reverification process. Notifications are sent to the NCTracks Message Center Inbox on the secure Provider Portal. Failure to respond will result in suspension and subsequent termination of the provider record.
A list of providers due for reverification through December 2023 is available on the Provider Enrollment Recredentialing webpage. The reverification due date is the suspension date if no action is taken. Please respond to notifications in a timely manner to maintain participation with NC Medicaid programs.
For additional information, please visit the Provider Re-credentialing/Re-verification page on the NCTracks Provider Portal.
Implementation of Tailored Plans -- Start Date Oct. 1, 2023
Providers are encouraged to remain informed of the implementation of Tailored Plans through fact sheets and other resources available in the Medicaid Managed Care Provider Playbook. The following Tailored Plan fact sheets have been updated and are available under the Medicaid Transformation option:
- Tailored Care Management
- Tailored Plan Enrollment and Timeline
- What Providers Need to Know Before Tailored Plan Launch
- What Providers Need to Know After Tailored Plan Launch
These documents include the following upcoming key milestones in preparation for Tailored Plan launch:
| July 15, 2023 | Tailored Plan Auto-Enrollment begins. |
| July 17, 2023 | Beneficiary Choice Period begins; Beneficiaries can choose a PCP by contacting their Tailored Plan |
| July 24, 2023 | Enrollment Broker begins mailing transition notices to beneficiaries. |
| Aug. 15, 2023 | Beneficiary Choice Period ends |
| Aug. 17, 2023 | PCP Auto-Assignment by the Tailored Plan for beneficiaries who have not selected a PCP. |
| Aug. 25, 2023 | Tailored Plans begin mailing Welcome Packets and ID cards to beneficiaries |
| Sept. 1, 2023 | Tailored Plan Pharmacy, Nurse and Behavioral Health Crisis lines go live |
| Oct. 1, 2023 | Behavioral Health and Intellectual/Developmental Disabilities (I/DD) Tailored Plans launch |
Keep NCTracks Provider Records Current
Medicaid Managed Care health plans, as well as the NC Medicaid Provider and Health Plan Lookup Tool must use information from the NCTracks provider record for their directories. For this reason, and because NC Medicaid recently announced a Provider Data Management/Credentialing Verification Organization Solution Coming in 2024, it is essential for providers to ensure all data in each active NCTracks provider record is accurate.
To assist with this effort and allow for the organization and basic review of multiple records concurrently, the Department continues to offer Provider Directory Listing and Affiliation Reports for Standard Plans and Tailored Plans in the Provider Playbook under Trending Topics. These reports are updated regularly and serve as a resource for verifying the contract status with health plans.
The ongoing accuracy of provider enrollment information is not only contractually required of providers, but also vital to the successful sharing of data among health plans and the incorporation into new solutions. For additional information, see the related bulletin article Ensure Your Information Displays Correctly in NC’s Provider Directory Tool – Provider & Health Plan Look-Up.
Provider Ombudsman
Each health plan has a grievance and appeal process for providers, separate from the process for beneficiaries, which can be found in the health plan’s Provider Manual, linked on the Health Plan Contacts and Resources Page.
The Provider Ombudsman service is separate from the Health Plans’ Provider Grievances and Appeals process and should be used as an escalation after contacting health plans and searching the NC Medicaid Help Center.
Inquiries may be submitted to Medicaid.ProviderOmbudsman@dhhs.nc.gov or by calling the NC Medicaid Managed Care Provider Ombudsman at 866-304-7062.
Responses to inquiries are autogenerated from ServiceNow and sent directly to thhttps://medicaid.ncdhhs.gov/blog/2021/03/01/nc-medicaid-help-center-now-available-convenient-way-providers-find-informatione inquirers email address. The subject line will read “NC Medicaid Inquiry COM00XXXXX Has Been Closed” and be sent from this email address: IT Service Desk Medicaid.HelpCenter@dhhs.nc.gov.
Help Center Available for Providers to Find Information
The NC Medicaid Help Center is an online source of information about NC Medicaid Managed Care, COVID-19, Medicaid and behavioral health services, and is used to view answers to questions from the NC Medicaid Help Center mailbox, webinars and other sources. To use this tool:
- Go to the NC Medicaid Help Center
- Type a topic or key words into the search bar
- Select a topic from the available list of categories
Detailed information about the NC Medicaid Help Center is available in a Medicaid Bulletin updated on June 17, 2021.
NC Medicaid Managed Care Webinars
Visit the AHEC Medicaid Managed Care webpage for additional information and registration for upcoming webinars, as well as recordings, slides and transcripts from previous webinars.
The latest schedule, registration and information on previous webinars, including the recording, slides, and transcript are available on the AHEC Medicaid Managed Care website.
Contact
NCTracks Call Center: 800-688-6696
Provider Ombudsman: 866-304-7062