Quarterly Provider Update – Fall 2025

Information on Credentialing Committee, Children and Families Specialty Plan (CFSP) and Upcoming Application Changes.

Credentialing Committee Launching Soon

A Credentialing Committee has been established to review provider files with flagged items that may impact the disposition of their NCTracks enrollment, reenrollment reverification application, as well as issues discovered through ongoing monitoring.

The committee, led by a Medical Director, will make quality determinations on provider files with issue findings from:

  • Primary source verifications
  • Disclosures
  • National Practitioner Data Bank queries (NPDB)
  • Ongoing monitoring

Membership will include both voting and non-voting member representatives from the NC Department of Health and Human Services (NCDHHS), payers and managed care health plans. The Credentialing Committee will meet weekly.

The NCDHHS Credentialing Committee continues toward an on-time launch of Sept. 28, 2025, with the first meeting planned for Oct. 8, 2025.

More information including official Committee bylaws, a fact sheet and frequently asked questions are available on the Credentialing Committee webpage.

Upcoming Provider Application Changes

The following provider enrollment application updates are effective Sept. 28, 2025, and were all made to meet National Committee for Quality Assurance (NCQA) standards.

Draft applications in the system at the time of implementation will be deleted. Providers should submit draft applications before Sept. 28, 2025, to prevent loss of data.

Key Changes include:

  • Updated exclusion sanction questions that providers are required to answer as part of their NC Medicaid enrollment application. Answering these questions affirmatively does not automatically disqualify a provider from NCDHHS program participation. However, failure to disclose can result in denial of the application and subsequent termination from all programs. For more information and to read the updated questions, please see the Updates to Exclusion Sanction Questions on Provider Enrollment Applications announcement.
     
  • A new attestation process has been created wherein individual and atypical individual providers completing initial enrollment, re-enrollment and reverification applications must attest that all information on the application is true, correct and complete to the best of their knowledge and belief. This attestation will be part of initial enrollment, re-enrollment and reverification applications submitted through the secured NCTracks provider portal. To review the attestation process, please visit the New Attestation Requirements for Individual Providers announcement.
     
  • NCTracks will capture an Individual provider’s race, ethnicity and languages spoken during Individual provider enrollment, re-enrollment, manage change requests and reverification applications. Responses are editable and offering this information is optional. Additional information is available in the New Demographic Data Collection on Provider Applications announcement.

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 NC Medicaid-enrolled children, youth and families currently and formerly 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, named Healthy Blue Care Together (HBCT), will go live on Dec. 1, 2025.

Site Visit Guidance for Physical Therapists

Physical Therapists who are enrolling with NC Medicaid are categorized as moderate risk, which generally requires a site visit.  However, there are special provisions when the individual enrolling with a Physical Therapist taxonomy is affiliating to an organization billing on their behalf.  

In the NCTracks application, Physical Therapists must answer questions regarding site visits. When prompted, those enrolling with Taxonomy 225100000X are advised to:

  • Answer “No” to "Have you completed the Federal site visit for this site to NC Medicaid, another state or Medicare?" when the individual is not billing under their individual NPI and the application includes an affiliation to an organization.
  • This will trigger a manual review and will prompt a site visit only when deemed necessary.

Note: This instruction is only applicable to Physical Therapist enrolling with an Individual enrollment type.

NC Medicaid Help Center & Provider Ombudsman

The Provider Ombudsman is separate from the managed care 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.

Implementation of Delegated Enrollment and Credentialing Placed on Hold

NC Medicaid is pausing the implementation of Delegated Enrollment/Credentialing until further notice. This initiative would allow NC Medicaid to delegate individual provider credentialing to major hospitals and large health care systems to perform enrollment credentialing activities for their health care practitioners. Due to limited administrative funding, the Department must pause the implementation of delegated enrollment and credentialing at this time. This will not impact Credentialing Committee implementation and operations.

For more information about provider enrollment, visit NC Medicaid’s Provider Enrollment webpage.

Recent Provider Communications

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

NC Medicaid Provider Bulletins

NCTracks Provider Announcements

Updated NCTracks Provider FAQs

Contact

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