Reminders About Required Provider Disclosures
NC Medicaid providers must accurately answer all Exclusion Sanction questions on enrollment and re-verification applications. This includes disclosing any past infractions involving owners, agents or managing employees, regardless of how long ago they occurred.
Current providers are also required to notify the Department within 30 calendar days of learning of any adverse action taken against any required license, certification, registration, accreditation, or endorsement of the provider or any of its officers, agents or employees.
Failure to disclose or provide documentation may result in application denial or termination of the provider record.
Please review the full bulletin here: Reminders About Required Provider Disclosures. Providers are also encouraged to read the full NCDHHS Provider Participation Agreement to ensure complete understanding of the requirements for participation with NCDHHS programs.
Children and Families Specialty Plan Flexibilities
With the launch of the Children and Families Specialty Plan (CFSP), we want to remind providers that flexibilities are in place. These are designed to ensure continuity of care and ease the administrative burden for providers with the start of the new health plan.
The flexibilities include medical (physical and behavioral health) and pharmacy prior authorizations, out-of-network provider rates and rules and primary care provider changes. For more details on the flexibilities, read the associated provider bulletin.
Important Updates for Case Manager/Care Coordinators
The Case Manager/Care Coordinator taxonomy (171M00000X) 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 will be added to NCTracks and the criterion for enrollment is displayed on the Provider Permission Matrix, available on the NCTracks Provider Enrollment webpage. This includes providers who offer Community Alternatives Program (CAP)-Consumer Direction, CAP for Children and CAP for Disabled Adults services.
Case Manager/Care Coordinators must ensure correct enrollment before March 1, 2026. To ensure correct enrollment, impacted providers should follow the steps outlined on the Important Updates for Case Manager/Care Coordinators - Taxonomy 171M00000X NCTracks announcement from Nov. 6, 2025 to enroll with taxonomy 171M00000X as an Individual Provider.
Federal Provider Enrollment Application Fee Increase for Year 2026
The federal fee for Medicaid enrollment will increase to $750 for calendar year 2026.
The Centers for Medicare & Medicaid Services (CMS) Federal Register 90 FR 55738 (see Medicare, Medicaid, and Children's Health Insurance Programs; Provider Enrollment Application Fee Amount for Calendar Year 2026) finalized provisions related to the submission of application fees as part of the Medicaid provider enrollment process for institutional providers and suppliers. This fee is adjusted annually based on the consumer price index for all urban consumers (CPI-U).
Beginning Jan. 1, 2026, the federal fee for Medicaid enrollment will increase from $730 to $750 for calendar year 2026. This will be required as noted on the Provider Permission Matrix for:
- Initial enrollment;
- Re-enrollment;
- Adding a new owner or a new site location; and
- Re-verification.
NCTracks provides a record of federal fees and NC Enrollment fees by year so providers may note the updates. The Federal Fees & NC Enrollment Fees by Year spreadsheet can be found under Quick Links on the Provider Enrollment page.
Additional information regarding the federal fee can be found on the public-facing NCTracks provider portal Federal Fee and NC Application Fee FAQs page.
NC Medicaid Webinars
Attending webinars can help providers stay informed about program initiatives and updates. The following webinars are upcoming.
NC Medicaid’s Provider Operations unit will host quarterly Virtual Office Hours webinars in 2026. These sessions will share provider enrollment hot topics and offer an interactive format for providers to ask questions on a variety of topics. The dates for 2026 are as follows:
- Thursday, Feb. 5, 2026, noon - 1 p.m.
- Thursday, May 7, 2026, noon - 1 p.m.
- Thursday, Aug. 6, 2026, noon - 1 p.m.
- Thursday, Nov. 5, 2026, noon - 1 p.m.
Dr. Janelle White, Chief Medical Officer of NC Medicaid, will host an upcoming Back Porch Chat on Feb. 19, 2026, and May 21, 2026.
Visit the Provider Playbook: Training Courses webpage to register for upcoming sessions. An archive of presentation slides from previous webinars is also available on this website.
Recent Provider Communications
Providers are encouraged to review the following content which has been recently created or refreshed.
NC Medicaid Provider Bulletins:
- Federal Provider Enrollment Application Fee Increase for Year 2026
- Providers with License Limitations or Non-Practice Agreements Ineligible for NC Medicaid Participation
- Refresher: How to Confirm Medicaid Coverage for Beneficiaries
NC Medicaid Fact Sheets:
- What Providers Need to Know After Children and Families Specialty Plan Launch (Part 2)
- Provider Quick Reference Guide for the Children and Families Specialty Plan
NCTracks Provider Announcements:
- NCTracks Helpful Hints: What is the Process to Update a Name, DOB and/or SSN on a Provider's Record?
- Upcoming Layout Changes for PPM
- Important Update for Taxonomies No Longer on the Provider Permission Matrix
- Important Updates for Case Manager/Care Coordinators - Taxonomy 171M00000X
- Electronic Funds Transfer Attestation Added to Reverification and Manage Change Request Provider Applications
- Update to NCTracks Provider Portal Taxonomy Classification Requirements
NC Medicaid Help Center and Provider Ombudsman
The Provider Ombudsman is separate from the NC Medicaid 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.
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.
Contact
NCTracks Call Center: 800-688-6696
Provider Ombudsman: 866-304-7062 or Medicaid.ProviderOmbudsman@dhhs.nc.gov