This bulletin applies to NC Medicaid Managed Care and NC Medicaid Direct.
Providers enrolled in NCDHHS programs are contractually required to maintain their provider record to ensure data accuracy, at all times. Keeping an accurate provider record prevents downstream impacts and adverse actions, including termination of taxonomies, locations and health plans.
By submitting an NCTracks Manage Change Request (MCR), providers can update their existing record data at no cost.
Taxonomy: Review for Accurate Screening
Providers must regularly review the taxonomies listed on their records to ensure that each one accurately represents services currently offered to NC Medicaid beneficiaries.
The Provider Permission Matrix (PPM) outlines enrollment requirements for individual, organizational and atypical providers by taxonomy, including fingerprinting, site visit, federal fee, licensure, accreditation and certification necessary for enrollment participation.
Risks of Incorrect Taxonomy
Failed Site Visit/Termination:
For NC Medicaid providers, site visits are conducted by Public Consulting Group (PCG). As required by 42 CFR 455.432, NC Medicaid must conduct pre-enrollment and post-enrollment site visits for Moderate and High categorical risk taxonomies. These visits are performed to verify that the information submitted to NC Medicaid is accurate and compliant with federal and state requirements.
PCG reviews active taxonomies on the provider record and validates that each accurately reflects the service rendered by the provider. If during a site visit the provider cannot demonstrate basic knowledge of expected services, the site visit is registered as a “fail.” This result is communicated to GDIT and results in automatic termination of participation or denial of the pending application. Maintaining accurate taxonomies on the provider record helps to ensure that the correct screening takes place.
Inaccurate Provider Directories:
NC Medicaid and all NC Medicaid Managed Care health plans publish provider directories which include information about available services based on active taxonomies. Incorrect data risks beneficiaries seeking services not available at the provider’s location, wasting time and effort for both the provider and the beneficiary.
Use Your Full Legal Name
NCTracks requires providers to use their full legal name (first, middle and last) as it appears on their government-issued identification. This name must also match:
- National Plan and Provider Enumeration System (NPPES)
- Applicable accreditation, certification and licensure agencies. For Drug Enforcement Agency (DEA), only first and last name must match.
- Employer Identification Number (EIN)/Taxpayer Identification Number (TIN)
Matching records allow NCTracks to complete credentialing and background checks successfully.
If the name on the NCTracks record does not match the government-issued ID, the provider may email NCTracksProvider@nctracks.com, and include documentation showing the correct legal name. GDIT will modify the name associated with the NCTracks record.
If the name associated with NPPES, the Drug Enforcement Agency (DEA) certification (except middle name) or other credentialing entities does not match the provider’s government-issued ID, the provider should contact the appropriate entity to reconcile the name.
Risks of Unmatched Name
Application Denial/Withdrawal and Additional Fee Payment
- Initial enrollment applications: If an initial enrollment application is submitted with an incorrect name, the provider must withdraw and submit a new application with their correct legal name. This will require a new payment of the NC Application fee.
- Re-enrollment, MCR or re-verification applications: The provider cannot alter their name on a pending application. The provider must:
- Upload a name change support document (driver license, marriage license or alternative government-issued proof of legal name) via the Upload Documents page for the pending application.
- The NCTracks Enrollment Specialist will correct the name on the existing record, notify the provider and withdraw the current application.
- The provider may then submit a new re-enrollment, MCR or re-verification application. This may require a new payment of the NC Application fee.
Processing Delays:
- Before submitting an application, confirm that the name matches across entities used for enrollment: Government-issued identification; NPPES; credentialing agency; DEA (except middle name); EIN/TIN (if applicable).
- Enter your name exactly as it appears on the government-issued identification. If the system limits the number of characters, spell out as much as possible, however, do not abbreviate.
For more details about acceptable documentation, please review the reference chart available on the NCTracks Helpful Hints: What is the Process to Update a Name, DOB and/or SSN on a Provider's Record? page.
Additional Resources
- The Provider Permission Matrix and instructions for using the PPM are located under Quick Links on the NCTracks Provider Enrollment webpage
- User guides for How to View and Update Taxonomy and How to Select a Taxonomy Code are located on the NCTracks User Guides & Fact Sheets webpage under the Taxonomy section
- NCTracks General Provider Enrollment FAQs
- Manage Change Request FAQs
- Provider Site Visits Valid for Five Years announcement
- Reminder of Update to Organization Name on Provider Record
Contact
- NCTracks Call Center: 800-688-6696
- Provider Ombudsman: 866-304-7062