NC Medicaid Provider Directory API Now Available
NC Medicaid has launched a Provider Directory Application Programming Interface (API) in accordance with the Centers for Medicare & Medicaid Services (CMS) Interoperability and Patient Access Final Rule (CMS-9115-F). The API provides public, electronic access to provider directory information for network providers across NC Medicaid Managed Care and NC Medicaid Direct and supports the same provider data used for the NC Medicaid Provider and Health Plan Lookup Tool. Provider information returned through the API is sourced from providers’ NCTracks provider record and supplemented with health plan contract data.
The Provider Directory API is available on the NC Medicaid Interoperability Portal. The Provider Directory API is public and does not require registration to use. No action is required to use the Provider Directory API.
However, providers are encouraged to review NCTracks provider records and submit updates as needed using the NCTracks Managed Change Request (MCR) process to help ensure accurate directory information is available to members and other directory users.
For questions related to your NCTracks provider information, contact the NCTracks Call Center at 800-688-6696. To update your information, log into the NCTracks Provider Portal to verify your information and submit an MCR or contact the NCTracks Call Center.
Provider Ombudsman inquiries, concerns or complaints can be submitted to Medicaid.ProviderOmbudsman@dhhs.nc.gov or the Provider Ombudsman line at 866-304-7062.
Behavioral Health Post-Enrollment National Accreditation Update
Organizational providers of Mental Health, Intellectual and Developmental Disabilities (I/DD) and Substance Use Disorder (SUD) services covered by North Carolina Department of Health and Human Services (NCDHHS) programs are reminded that achievement of national accreditation is required per NC Gen Stat § 122C-81 (2023), Medicaid clinical coverage policies, the North Carolina Medicaid State Plan and Division of Mental Health, Developmental Disabilities and Substance Use Services (DMHDDSUS) State-funded Service Definitions.
The requirement for a provider to achieve national accreditation can either be one or three years after initial NCTracks Medicaid provider enrollment, except for providers of Innovation Waiver services. Providers are advised to initiate the process of obtaining national accreditation if the requirement has not been met or is not already in progress.
Additional information is available in the Post-Enrollment National Accreditation Update bulletin.
Disclosure Requirements for Current Providers
Under NC Gen Stat 108C-4, and Section 8 of the NCDHHS Provider Administrative Participation Agreement, currently enrolled providers are required to notify the Department within 30 calendar days.
This includes:
- Any adverse action taken against any required license, certification, registration, accreditation or endorsement of the provider or any of its owners, agents, managing employees or other individuals active in the record.
- Any changes to the criminal convictions of anyone listed on the provider enrollment record to comply with the Department’s review of criminal history.
Failure by currently enrolled providers to disclose adverse actions within 30 days as contractually required may result in termination of their NCTracks provider record.
Providers can report changes through the submission of an MCR on the NCTracks secure provider portal.
Risks of Not Accurately Reporting on Your NCTracks Provider Record
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.
The recently published Providers: Risks of Not Accurately Reporting on Your NCTracks Provider Record bulletin details the risks present when provider records are not kept up-to-date. This bulletin shares important information about what can happen when taxonomies are incorrect and using your full legal name on provider applications. Resources for providers are also included.
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 remaining dates for 2026 are as follows:
- 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. Brittany Watson, Associate Medical Director Consultant of NC Medicaid, will host an upcoming Back Porch Chat on May 21, 2026, and Aug. 20, 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.
Connecting Communities & Medicaid (CCM) is a monthly NC Medicaid workgroup focused on strengthening partnerships between community organizations and Medicaid to improve access to care and address drivers of health. All meetings are held virtually on Zoom on the second Wednesday of each month at 8:30 a.m. Discussions include topics on H.R. 1 and federal changes to Medicaid, including upcoming impacts to eligibility and program operations. If you are interested in joining, please visit the CCM webpage.
Recent Provider Communications
Providers are encouraged to review the following content which has been recently created or refreshed.
NC Medicaid Provider Bulletins:
- Reminders About Required Provider Disclosures Including Expungements
- Providers: Risks of Not Accurately Reporting on Your NCTracks Provider Record
- Behavioral Health National Accreditation Requirements Provider Update
- Refresher: How to Confirm Medicaid Coverage for Beneficiaries
NC Medicaid Fact Sheets:
- Introduction to Standard Plan
- Provider Quick Reference Guide for Standard Plans
- 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 & Frequently Asked Questions:
- Reminder: Action Required: Enrollment Update for CAP Case Managers/Care Coordinators
- New, My Account Management Page Available to Providers in NCTracks
- Exclusion Sanction Questions FAQs
NC Medicaid Help Center and Provider Ombudsman
The Provider Ombudsman is separate from the 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