This information applies to both NC Medicaid Managed Care and NC Medicaid Direct providers.
This topic will be discussed at an upcoming Virtual Office Hours webinar co-hosted by NC Medicaid in partnership with NC AHEC on Thursday, June 5, 2025, from 12-1 p.m. Visit the NC AHEC Medicaid Managed Care Trainings webpage to register for this session. This session will be recorded and available on the NC AHEC website, as well.
Individual Enrollment Required for Opticians
The Optician taxonomy (156FX1800X) has been available to providers as an Organization enrollment type but is intended for Individual provider enrollment, only.
The ability for providers to select this taxonomy under an Individual enrollment type has been added to NCTracks and the criterion for enrollment is displayed on the Provider Permission Matrix, available on the NCTracks Provider Enrollment webpage.
Individual Opticians and their affiliated organizations must ensure correct enrollment before Sept. 1, 2025, to retain the ability to enter visual aid prior approval (PA) requests in NCTracks and receive payment for dispensing approved visual aids. Otherwise, prior approval requests will be rejected in the NCTracks PA portal when an Optician taxonomy (156FX1800X) is used in conjunction with an organization NPI. To ensure correct enrollment, Opticians and their affiliated organization must complete the following steps, as necessary.
For the Individual practitioner:
- Obtain an individual NPI, through the National Plan and Provider Enumeration System (NPPES).
- Complete the provider enrollment process through NCTracks to enroll the individual with NC Medicaid. Job Aids and resources are available on the NCTracks Provider Enrollment webpage to assist with the enrollment process.
- Affiliate the individual to the organization NPI billing on their behalf. This can be done during the initial enrollment application or after approval, using the Manage Change Request process.
Note: If the individual Optician is actively enrolled with NC Medicaid and affiliated with the organization billing on their behalf, the above steps are considered complete. See below for actions that may be needed for the organization.
Organization Provider Enrollment Record Changes May be Required
For the organization NCTracks record:
Review the active taxonomies for each location on the organization record. This is done by beginning a Manage Change Request on the NCTracks Secure Provider Portal for the organization NPI and navigating to the Taxonomy Classification page:
a. If a taxonomy other than Optician (156FX1800X) is active at each location and can be used to bill related services (e.g. Single Specialty), then no additional action is required.
b. If an Optician taxonomy (156FX1800X) is the only taxonomy active for the location, then an additional taxonomy (e.g. Single Specialty) must be added. Submit a Manage Change Request making the appropriate taxonomy selection (e.g. Single Specialty)
c. "How to View and Update Taxonomy" and "How to Select a Taxonomy" user guides are available to assist with this process.
Once the individual Optician is enrolled and affiliated, the organization can begin billing using the individual NPI/taxonomy as the rendering provider and the organization's NPI/taxonomy as the billing provider, as appropriate.
Contact Lens and Contact Lens Fitter Taxonomies
Effective Dec. 1, 2025, Contact Lens (156FC0800X) and Contact Lens Fitter (156FC0801X) taxonomies will be terminated in NCTracks. Providers enrolled with either of these taxonomies must ensure an additional active Optician taxonomy (156FX1800X) for each location where services are rendered. If there is not an Optician taxonomy (156FX1800X) on the Individual provider record, submit a Manage Change Request on the NCTracks Secure Provider Portal and add Optician taxonomy (156FX1800X) before Dec. 1, 2025, to ensure continued payment.
Provider Fees
- There is no fee to process a Manage Change Request in NCTracks to add a taxonomy for a provider who is already enrolled in NC Medicaid.
- The North Carolina Provider Application fee to enroll a new, individual Optician is $100.
Contact
NCTracks Call Center: 800-688-6696
Provider Ombudsman: 866-304-7062