NC Medicaid Managed Care Provider Update – March 27, 2024

Includes information on Provider Fact Sheets, LME/MCO consolidation, Innovations and TBI waivers, federal fee increase, updates to NCTracks and more.

Updated Provider Fact Sheets

NCDHHS updated Fact Sheets in the NC Medicaid Managed Care Provider Playbook to reflect the July 1, 2024, launch of Tailored Plans.

LME/MCO consolidation

LME/MCO consolidation, dissolving Sandhills Center and consolidating Eastpointe and Trillium Health Resources, was effective Feb. 1, 2024. The Department posted an LME/MCO Consolidation Overview and FAQs – For Providers that offered additional details on consolidation components, impacts to beneficiaries, and guidance to providers.

Appendix K: Flexibilities Approved for Innovations and Traumatic Brain Injury Waivers

On Nov. 22, 2023, the Centers for Medicare and Medicaid Services (CMS) approved North Carolina Medicaid to continue certain Appendix K flexibilities in the 1915 (c) Innovations Waiver and TBI (Traumatic Brain Injury) Waiver amendment, effective March 1, 2024.

Federal Fee Increase for Provider Enrollment

Effective Jan. 1, 2024, the federal fee for Medicaid provider enrollment increased to $709 and will be required as noted on the Provider Permission Matrix for initial enrollment, re-enrollment, and reverification applications, as well as manage change requests (MCR) to add a new site location.

Additional information regarding the federal fee can be found at  Medicare, Medicaid, and Children's Health Insurance Programs; Provider Enrollment Application Fee Amount for Calendar Year 2024.

New Exclusion Sanction Questions added to Applications for Provider Enrollment

Beginning Jan. 28, 2024, five additional exclusion sanction questions were added to provider enrollment, re-enrollment, full managed change requests (MCRs), office administrator (OA), and re-verification applications.

Additional information about the new exclusion sanction questions can be found in the NCTracks Provider Announcement.

Provider Enrollment Terms and Conditions Updated

The NCDHHS Provider Administrative Participation Agreement, Consent to Release Information, EFT Attestation, the NCDHHS OPR Provider Participation Agreement, and the NCDHHS Out or State Lite Provider Participation Agreement have been updated in the NCTracks Provider Portal. Providers are encouraged to read each term and condition requiring their signature prior to submission of their application. All terms and conditions of provider enrollment are available on the public-facing NCTracks Provider Enrollment webpage.

License Accreditation Certification

An NCTracks automated process scans each record for an expiring credential (license, accreditation, certification) and initiates letters to providers 60 days prior to expiration. Although NC Medicaid has established a relationship with several credentialing entities to receive files and automatically update applicable credentials, it is ultimately the responsibility of the provider to ensure credentials are updated prior to expiration. If no action is taken to update the credential, and the system cannot automatically update the expiration, the associated taxonomy code(s) will be suspended. A suspension letter is generated and sent to the provider’s Message Center Inbox with the subject Recertify Suspension Letter. The suspension will remain in place for another 60 calendar days unless the credential is renewed, which will lift the suspension. Note: Suspension means the claims will pend and will not continue adjudicating until the suspension is lifted. See NCTracks License and Accreditation FAQs for additional information.

NC Medicaid Managed Care Information and Resources

Providers are encouraged to remain informed of NC Medicaid Managed Care Transformation through the following resources:

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 the health plan(s) and seeking guidance through the NC Medicaid Help Center.

Inquiries may be submitted to 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 assigned to help resolve the inquiry. When the inquiry is considered resolved and closed, a final email with subject line “NC Medicaid Inquiry COM00XXXXX Has Been Closed” will be sent from

NC Medicaid Webinars

Visit the NC AHEC Medicaid Managed Care webpage for additional information and registration for upcoming webinars and Virtual Office Hour sessions. Webinars inform providers of program initiatives and updates within NC Medicaid Attendance is vital to staying informed. Recordings, presentation slides, and transcripts from previous webinars are available.

Virtual Office Hours for Providers: June 6, 2024, at 5:30 p.m. | Provider Enrollment registration


NCTracks Call Center: 800-688-6696 
Provider Ombudsman: 866-304-7062 or

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