Quarterly Provider Update – Spring 2025

NC Medicaid Help Center & Provider Ombudsman

The Provider Ombudsman  is separate from the health plans’ issue resolution processes and should be used only after contacting the health plan(s) or seeking information and guidance through the NC Medicaid Help Center. 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. Inquiries may be submitted to Medicaid.ProviderOmbudsman@dhhs.nc.gov or by calling the Provider Ombudsman at 866-304-7062.

Multi-Factor Authentication (MFA) will be Required for All NCTracks Users 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. Users will be contacted by email when their account is scheduled to transition to MFA. If not already using MFA to log into NCTracks, users may also proactively follow the steps below to update all NCID profiles associated with your account:

Note: These instructions are for Individual and Business users only, not Local and State Government users.

1. Login to the MyNCID portal at https://myncid.nc.gov/ with your NCID Username and Password.
2. The Profile Information page upon successful login.
3. Click on the MFA tab on the profile page.
4. Click on the ADD ENROLLMENT button on the bottom right.
5. A pop-up window will appear prompting you to choose an MFA method. Please note that office phone extensions are not supported.
6. Follow the onscreen prompts to add the chosen MFA method.

For detailed instructions, including images of each step, refer to the NCID User Guide for MFA. For issues during login or authentication, please contact the Department of Information Technology (DIT) helpdesk at 919-754-6000 or 800-722-3946, then select Option 1. For more information and training videos, visit the NCID Citizen Identity Project | NCDIT training page.

Important Note: When MFA has been implemented for your NCTracks profile, all profiles, including MFA, will be managed through https://myncid.nc.gov/

REMINDER: Electronic Funds Transfer (EFT) Authorized Managing Relationship Role

To enhance the security of the Electronic Funds Transfer (EFT) information on the NCTracks provider enrollment record, the option for providers to report an “EFT Authorized” individual was added to the Agents and Managing Employees application page in 2022. This allows providers to name an additional contact to validate the need for an EFT change to the NCTracks record.

To add this type of managing relationship, submit a full Manage Change Request (MCR), navigate to the Agents and Managing Employees page, and add the appropriate individual’s information, selecting “EFT Authorized” from the Business Relationships offered. More information is available in the NCTracks announcement titled Enhanced Security for OA Change Requests and EFT Change Requests.

Children and Families Specialty Plan Launching Later this Year

The Children and Families Specialty Plan (CFSP) is a first-of-its-kind statewide health plan to ensure access to comprehensive physical and behavioral health services for Medicaid-enrolled children, youth and families served by the child welfare system with seamless, integrated and coordinated care. The first CFSP contract was awarded to Blue Cross Blue Shield NC after a competitive selection process, and the term will last four years. The plan will go live on Dec. 1, 2025.

Healthy Blue Care Together (HBCT) will provide outreach to providers seeking interest in CFSP as well as to providers that are not currently contracted to Healthy Blue.

For more information about CFSP, please visit the Children and Families Specialty Plan webpage.

Credentialing Committee Planned for Fall 2025

A Credentialing Committee will be established to review NC Medicaid practitioner files that have flagged items for disposition of their enrollment/reenrollment/recredentialing applications and ongoing credentialing oversight for all NC Medicaid, Division of Mental Health, Developmental Disabilities and Substance Use Services, Division of Public Health, Office of Rural Health and Managed Care health plans.

The committee will make quality determinations on provider files with issue findings from primary source verifications, disclosures, National Practitioner Data Bank queries (NPDB), and ongoing monitoring. Led by a Medical Director, voting and non-voting members from NCDHHS payers and managed care health plans will make up the Credentialing Committee, which will meet weekly to review the flagged providers. The tentative launch date of the Credentialing Committee is early October 2025.

Questions can be emailed to: medicaid.credcommittee.stakeholders@dhhs.nc.gov

Delegated Credentialing Planned for Spring 2026

The NC Medicaid Provider Operations team is working to establish and implement a Delegated Enrollment and Credentialing process through the NCTracks system. Delegated Credentialing allows NC Medicaid to delegate credentialing to major hospitals and large health care systems who will use National Committee for Quality Assurance (NCQA), federal, and State guidelines to perform credentialing activities for their health care practitioners. This allows for a more streamlined process for large systems to credential their individual practitioners. Delegated Credentialing is tentatively scheduled to launch by March 2026.

The NC Medicaid Provider Operations team will continue to share updates about this initiative and upcoming stakeholder engagement opportunities. Questions can be emailed to medicaid.delegatedcredentialing.stakeholders@dhhs.nc.gov

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:

• Telehealth Program

Updated NCTracks Provider FAQs:

• Common Enrollment Application Issues FAQs
• Federal Fee and NC Application Fee FAQs
• Manage Change Request FAQs

NC Medicaid Webinars

Attending webinars co-hosted by NC AHEC in partnership with NC Medicaid can help providers to stay informed about program initiatives and updates.

• Dr. Janelle White, Chief Medical Officer of NC Medicaid, will host an upcoming Back Porch Chat on May 15, 2025.
• NC Medicaid’s Provider Operations unit will host a Virtual Office Hours webinar on June 5, 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.

Visit the NC AHEC Medicaid Managed Care Trainings webpage to register for upcoming sessions. Recordings, presentation slides and transcripts from previous webinars are available.

Contact

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