NC Medicaid Managed Care Provider Update February 17, 2025

Information on Hurricane Helene Flexibilities, OPR Updates, MFA for All NCTracks Users, and more.

NC Medicaid Temporary Flexibilities Due to Hurricane Helene

NC Medicaid remains committed to North Carolina's response to and recovery from Hurricane Helene. We are working with county and federal partners to make it faster and easier for beneficiaries to receive (and for healthcare professionals to provide) Medicaid services.

The flexibilities outlined in the Hurricane Helene Policy Flexibilities to Support Providers and Members - Dec. 12, 2024 bulletin are effective from Sept. 26, 2024, through the end of the Public Health Emergency on Feb. 28, 2025, unless otherwise communicated by the North Carolina Department of Health and Human Services (NCDHHS).

As a reminder, providers should always check NC Medicaid eligibility in NCTracks to confirm beneficiary enrollment in NC Medicaid, especially when the beneficiary presents without a Medicaid ID or their health plan ID card, to determine which health plan the beneficiary is enrolled in and whether their eligibility remains current.

Ordering, Prescribing, or Referring (OPR) Provider Updates Available

NC Medicaid published a new bulletin, Federal Regulation Guidelines for Ordering, Prescribing or Referring Providers, to provide guidance regarding enrollment requirements for OPR providers, as well as information regarding the requirement for ordering and referring NPIs to be included on claims. The information shared in this bulletin supersedes the September 2016 Medicaid Ordering, Prescribing or Referring (OPR) Special Bulletin. The 2016 OPR Special Bulletin should no longer be used as reference.

The NCTracks Provider Portal is also updated.

Education Transcripts No Longer Required for North Carolina Medical Board Licensed Providers

As of Jan. 8, 2025, school education and training transcripts are no longer required for North Carolina Medical Board (NCMB) licensed providers. This change simplifies the process for providers and streamlines resources, while maintaining compliance with National Committee for Quality Assurance (NCQA) standards.

Currently, NCTracks requests that some providers submit their school transcripts as proof of the highest level of education listed on their application. NCMB’s primary source verification (PSV) process verifies education and training, eliminating the need to request transcripts.

A list of additional state license agencies that can be used by NCTracks as primary source verification of education and training is available on the NCTracks Provider Supplemental Information FAQs page under Resources.

Provider National Accreditation Post-Enrollment Requirements

Refer to Program Specific Clinical Coverage Policies for additional requirements.

When the Provider Permission Matrix (PPM) displays a requirement for national accreditation for the taxonomy and/or service selected, the national accreditation is required prior to approval for participation with NC Medicaid under that taxonomy. In addition, some behavioral health services require national accreditation within one year or three years of the initial enrollment as an NC Medicaid provider.

Information about these post-enrollment national accreditation requirements is not currently available on the PPM. A review of the program specific clinical coverage policy is required. For more information about potential requirements for post-enrollment credentials, please reference the relevant clinical coverage policy found on the NC Medicaid Program Specific Clinical Coverage Policies webpage.

Federal Fee Increase for Calendar Year 2025

Effective Jan. 1, 2025, the federal fee for Medicaid provider enrollment increased to $730 and is required as noted on the Provider Permission Matrix for initial enrollment, re-enrollment, and reverification applications, as well as adding a new owner or a new site location.

Additional information regarding the federal fee can be found at Federal Provider Enrollment Application Fee Increase for Year 2025.

MFA & Password Requirements for All NCTracks Users Coming Soon

In accordance with the North Carolina Identity Management (NCID) Citizen Identity Project, NCTracks is changing the User Login process and implementing Multi-Factor Authentication (MFA) updates for all NCTracks users in 2025. This transition will occur in phases, and users will be contacted via email when their account is scheduled to change to MFA. Users can proactively follow the steps listed in the Multi-Factor Authentication (MFA) will be Required for All NCTracks Users Soon announcement to update all NCID profiles associated with their account.

Additionally, effective Jan. 26, 2025, all new NCID passwords require a minimum of 14 characters. This NCID password requirements change was made as an effort to ensure compliance with State policies and federal requirements.

Notification Required for Change of Ownership

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:

  1. Complete all applicable fields within the CHOW form
  2. Email the form and any supporting documentation to medicaid.chow.workgroup@dhhs.nc.gov

In conjunction with submitting the Disclosure Form, both the seller and buyer must make changes to the NCTracks enrollment record as applicable to reflect the intended structure of the enrollment record under the buyer. Review the recently published Notification Required for Change of Ownership bulletin for information regarding the enrollment, termination or modification of the NCTracks provider enrollment record due to a CHOW.  

NC Medicaid Webinars

Attending webinars and Virtual Office Hours facilitated by NC AHEC in partnership with NC Medicaid is a great way for providers to stay informed about program initiatives and updates.

  • NC Medicaid’s Provider Operations unit will host a Virtual Office Hours webinar on March 6, 2025, from 12-1 p.m. These quarterly sessions offer an interactive format for providers to ask questions on a variety of topics, including NC Medicaid Managed Care and provider enrollment.
  • The most recent Fireside Chat webinar, hosted by Dr. Janelle White, Chief Medical Officer of NC Medicaid, took place on Feb. 13, 2025, from 12-1 p.m. A recording of the webinar, as well as the slides presented is available through the NC AHEC website.

Visit the NC AHEC Medicaid Managed Care webpage for additional information and registration for upcoming sessions. Recordings, presentation slides, and transcripts from previous webinars are available.

Updated Provider Fact Sheets & Frequently Asked Questions

Providers are encouraged to review the following content which has been recently created or refreshed.

NC Medicaid updated Fact Sheets are in the NC Medicaid Managed Care Provider Playbook:

Updated NCTracks Provider FAQs:

Stay Informed with NCTracks Provider Announcements

NCTracks Provider Announcements are an important way to stay up to date. Email announcements on a wide variety of topics are regularly sent to enrolled providers and those who join the mailing list, which is open to the public. To sign up for NCTracks announcements, visit the public facing NCTracks Provider Communication page and look for the “Sign Up for NCTracks Communications” section on the right hand side of the page. An archive of provider announcements is also available on this page.

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 webpage.

The NC Medicaid 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 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 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 Medicaid.HelpCenter@dhhs.nc.gov.

Contact

NCTracks Call Center: 800-688-6696
Provider Ombudsman: 866-304-7062 or Medicaid.ProviderOmbudsman@dhhs.nc.gov

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