Note: This bulletin has been superseded by the Implementation of Provider Data Management/Centralized Verification Organization on Hold bulletin dated Oct. 22, 2024.
The North Carolina Department of Health and Human Services (NCDHHS) will be replacing the current provider enrollment and data management system components of NCTracks with a centralized Provider Data Management/Credentialing Verification Organization (PDM/CVO) solution. The solution will meet National Committee for Quality Assurance (NCQA) standards and enhance provider credentialing through centralized CVO features that include a Credentialing Committee and delegated enrollment and credentialing.
NCDHHS awarded a contract to Optum for the design, development and implementation of the PDM/CVO. To allow for additional time to test the system and ensure that providers and NCDHHS payers experience a seamless transition to the new solution, the PDM/CVO launch is now anticipated in 2026.
Upon launch, the PDM/CVO solution will:
- Consolidate all provider data to create an accurate directory for credentialing and health plan enrollment functions, reducing administrative redundancy for providers.
- Simplify enrollment, data maintenance and revalidation processes.
- Facilitate centralized credentialing on behalf of NCDHHS payers and health plans.
- Potentially mitigate reimbursement errors caused by outdated provider data.
- Allow for delegated enrollment and credentialing with hospitals and large health care systems where enrollment and credentialing activities are completed by the delegated entity for limited risk providers.
- Align North Carolina’s credentialing process with NCQA standards.
- Establish a representative centralized Credentialing Committee with multi-payers.
In preparation for the transition to the new PDM/CVO, providers are encouraged to:
- Maintain an accurate provider record. Reviewing all provider records and correcting outdated information is essential to ensure data from NCTracks provider records is accurately transferred to the new system.
- Stay informed. Review the NC Medicaid Provider webpage often and read all new NC Medicaid bulletins.
- Participate in educational opportunities. Respond to opportunities to learn more about the PDM/CVO, including participating in webinars and other events, to be fully prepared for the new system.
- Express interest in User Acceptance Testing (UAT). User Acceptance Testing (UAT) is expected to take place beginning in mid-2025 and will be a great opportunity for providers to test the system and offer their valuable insight into this transition. If you or members of your organization are interested in participating in UAT, please email medicaid.pdmcvo.stakeholderengagement@dhhs.nc.gov.
For the most up-to-date provider information including fact sheets and other applicable resources, please visit the NC Medicaid Provider Data Management / Credentialing Verification Organization webpage.