Reverification Timeliness and Requirements Clarification

States must revalidate the enrollment of all providers at least every five years to ensure the information on record is accurate and current.

Providers should check their message center inbox frequently and act promptly upon receipt of the initial notification to complete the Reverification process. Delinquent submissions result in suspension of claims and potential termination from the Medicaid program.

Suspensions and terminations are automated system actions in NCTracks which are triggered by dates and allow for no intervention. Providers should make every effort to meet the deadline stated in the notice.

It is important to remember that additions and corrections cannot be made to an application that has already been submitted and is processing through the system. Providers who act immediately upon receipt of the reverification notice have 70 days to complete the process. This allows ample time to re-submit a reverification application if a provider receives correspondence from NCTracks advising of errors or omissions.  

DHHS reports that most reverification failures resulting in program termination apply to non-compliant providers. A non-compliant provider is defined as one who fails to act in accordance with a requirement. A delinquent submission of the federally required Reverification application is non-compliant in that required deadlines are not met.

Many providers take no action until after they learn their claims have been suspended and they are unable to receive payment. This poses great risk. Once a suspension is in place, a provider is past his reverification due date, and only two scenarios are possible:

  • An application can be submitted (lifting the suspension) and processed through the system to completion with no errors, resulting in a successful reverification; or,
  • An application can be submitted (lifting the suspension), but errors or omissions result in the reverification being abandoned, withdrawn, or denied. Because the due date for submission has passed, any of these outcomes result in immediate termination of the provider’s NCTracks enrollment record.

When NCTracks identifies errors and/or omissions, a notice is sent to the provider advising of action required. Additions and corrections cannot be made to an application that has already been submitted; therefore, the notice also warns the provider of the potential consequence of the application being abandoned, withdrawn, or denied if their reverification due date has already passed. When this occurs, providers must submit a re-enrollment application and pay any applicable fees if they wish to continue participation in DHHS programs.

With respect to processing time frames mentioned in previous articles, there are references to 70-day and 50-day deadlines. Providers do not have an additional 50 days from the date of an application submission to resolve errors and omissions.

Non-responsive providers (providers who have taken no action to begin the reverification process) will be automatically terminated from the program on the 50th day following the date their claims have been suspended.

For more information about re-verification, visit the NCTracks Provider Re-credentialing/Re-verification webpage.


NCTracks Call Center - 800-688-6696

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