Beginning Oct. 1, 2025, NC Medicaid will deny initial, re-enrollment or reverification applications, and/or terminate an existing enrollment for providers when:
- There is an active licensing board order with a license limitation restricting:
- A provider’s range of service,
- The manner in which services are rendered that deviates from the prevailing procedure for administering the service, or
- The type of patients they are permitted to be served.
- There is a current public Non-Practice Agreements (NPAs). NPAs are entered into by a practitioner and the North Carolina Medical Board.
This is in accordance with Code of Federal Regulations § 455.412 Verification of provider licenses, which states that the State Medicaid agency must:
- (a) Have a method for verifying that any provider purporting to be licensed in accordance with the laws of any State is licensed by such State.
- (b) Confirm that the provider's license has not expired and that there are no current limitations on the provider's license.
Impact on Currently Enrolled Providers
If a currently enrolled provider is issued a licensing board order containing a limitation or enters into an NPA, termination will be effective the date of the order or NPA, for the full period of time the practitioner is under any agreement limiting their license or ability to practice.
License limitations do not pertain to practitioners that have a faculty, special purpose or military license. These license types are acceptable.
Upon reinstatement by the licensing board, providers may apply for reenrollment with the NC Medicaid program.
Contact
- NCTracks Call Center: 1-800-688-6696
- Provider Ombudsman: 1-866-304-7062