Re-credentialing/reverification is an evaluation of a provider’s ongoing eligibility for continued participation in NC Medicaid, normally conducted every five years as mandated 42 CFR 455.414. The COVID-19 federal Public Health Emergency (PHE) paused reverification from March 2020 through May 11, 2023, delaying the due date for nearly 30,000 providers over that three-year period. Now that the federal PHE has ended, NC Medicaid must ensure that all enrolled providers, including those whose reverification was delayed, are compliant with the federal regulation.
Reverification is required for continued participation with NC Medicaid programs. Providers for whom reverification was delayed have been organized into groups to ensure the timely completion of the reverification process.
- Providers should monitor their secure NCTracks Message Inbox for notifications and the Re-verification section of their NCTracks Status and Management page for the option to reverify.
- Reverification notifications are sent to the provider 70 days prior to the reverification due date, with reminders at 50 days, 20 days and five days.
- Non-responsive providers receive a notice of suspension offering an additional 50 days to submit their reverification application before being terminated from the program.
- Including the notice of termination, and depending on the provider’s responsiveness, each will receive up to 6 targeted notifications over the 120-day reverification period.
- If terminated, the provider may re-enroll at any time.
For help with the reverification process, providers can refer to the Provider Re-credentialing/Re-verification webpage in the NCTracks public facing portal. Providers are also encouraged to review Provider Announcements, User Guides and Frequently Asked Questions.
As a convenience, NC Medicaid offers a list of “Active Provider Re-Verification Due – July 2023 – Dec 2023” dates (updated biannually). The reverification due date displayed is also the suspension date if no action is taken to submit the reverification application under the applicable NPI. If the provider record is suspended, claims payment will stop until the reverification application is submitted.
Providers are encouraged to review the reverification due date list, and frequently check their NCTracks Provider Message Inbox for notifications or the reverification section of the Status and Management page in the NCTracks Secure Portal for the option to reverify.
Contact
NCTracks Call Center: 800-688-6696