Consistent with state and federal law, NCDHHS requires notification of any change of ownership (CHOW) for providers enrolled as a NC Medicaid provider. The enrolled provider must notify the Department at least 30 days prior to the effective date of any CHOW.
Providers will need to complete the Provider Change of Ownership Disclosure Form. The form is located on the NCTracks Providers webpage under Quick Links.
Once the form is downloaded, the Provider will need to:
- Complete all applicable fields within the CHOW form
- Email the form and any supporting documentation to medicaid.chow.workgroup@dhhs.nc.gov
In addition to submitting the Disclosure Form, both the former and new owner must make changes to the provider’s NCTracks enrollment record. For information regarding the enrollment, termination or modification of the NCTracks Provider Enrollment record due to a CHOW, review the Change of Ownership (CHOW) FAQs and follow the instructions as applicable to the intended structure of the NCTracks enrollment record under the new owner.
Contact
NCTracks Call Center: 800-688-6696