Provider Reverification
A new bulletin is available as of Sept. 11, 2023, to assist providers with common issues encountered with the reverification process. See Provider Reverifications Reminders for information.
Reverification is required upon notification from NCTracks. A list of providers due for reverification through December 2023 is available on the Provider Enrollment Recredentialing webpage.
- 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.
- If no action is taken by the reverification due date, NC Medicaid participation for that provider will suspend and ultimately terminate.
- Please respond to notifications in a timely manner to maintain participation with NC Medicaid programs.
Reverification resources, are available on the NCTracks Provider Re-credentialing/Re-verification page.
Medicaid Expansion Will Launch Dec. 1, 2023
Medicaid Expansion will launch on Dec. 1, 2023, giving more than 600,000 North Carolinians access to health care. For more information, please see the Medicaid Expansion webpage or the Questions and Answers about Medicaid Expansion webpage.
Ad Hoc AMH Medicaid Direct/Managed Care PCP Enrollee Report
To support Primary Care Providers in preparing to receive new Medicaid expansion members on Dec. 1, 2023, DHB has worked to create an ad hoc AMH Medicaid Direct/Managed Care PCP Enrollee Report (“PCP Enrollee Report”) that will be delivered to providers on Nov. 20, 2023, in their secure NCTracks Provider Portal.
This ad hoc report will include future-dated assignments to share the Medicaid expansion members that will be on provider panels starting Dec. 1, 2023. For more information on the existing PCP Enrollee Report, please see this Fact Sheet.
NC Medicaid Managed Care Information and Resources
Providers are encouraged to remain informed of NC Medicaid Managed Care Transformation through the following resources:
- Medicaid Managed Care Provider Playbook. Trending Data: Interim Reports to assist providers with verifying their record and PHP contracted information continue to be updated.
- Fact Sheets: NC Transition of 1915(b)(3) Benefits to 1915(i) is a new fact sheet available under NC Medicaid Programs and Services.
- Health Plans webpage – Contact information for all health plans, as well as health plan contract requirements and information.
- NC Medicaid Managed Care County Playbook – The playbook includes fact sheets on various community partner topics and notices received by beneficiaries transitioning to managed care.
- Financial and Statistical Reports – Contains a variety of dashboards and reports related NC Medicaid activities.
Keep NCTracks Provider Records Current
The ongoing accuracy of provider enrollment information is contractually required of providers and essential to ensure notifications regarding provider participation are received. It is also vital to the successful sharing of provider data among health plans and to correctly displaying the availability of services in NC Medicaid and the Standard Plan provider directories.
Although important for all providers, it is critical that individual providers affirm that the correct Office Administrator is actively managing the provider record and responding to notifications of required actions. NCTracks will place notifications into the Provider’s secure Message Inbox and send an email to the email address of record. If this contact information is incorrect, notifications are not received, and the record is at risk of suspension or termination.
In addition, NC Medicaid has announced the development of a new provider data management and credentialing verification organization solution. Data from the current provider record will be converted into the new system, making it imperative that information be current.
Providers may utilize the Manage Change Request process on the NCTracks secure Provider Portal Status and Management Page to review their record and make applicable updates. If additional assistance is needed, contact the NCTracks Call Center at 800-688-6696.
Provider Ombudsman
The health plan grievance and appeal process for providers 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’ process and should be used only as an escalation after contacting health plans and seeking guidance through 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 may be autogenerated from ServiceNow to the inquirer’s email or received from a Provider Ombudsman team member interested in helping to resolve your inquiry. When your inquiry is considered resolved and closed, a final email with subject line “NC Medicaid Inquiry COM00XXXXX Has Been Closed” will be sent from Medicaid.HelpCenter@dhhs.nc.gov.
NC Medicaid Webinars
Visit the AHEC Medicaid Managed Care webpage for additional information and registration for upcoming webinars and virtual office hour sessions. Webinars inform providers of all happenings within NC Medicaid, making attendance vital to staying informed. Recordings, slides and transcripts from previous webinars are available.
Contacts
NCTracks Call Center: 800-688-6696
Provider Ombudsman: 866-304-7062