Drug Enforcement Administration Pharmacy Update
The Drug Enforcement Administration (DEA) regulates both the prescribing and distribution of controlled substances. An active United States DEA certification is required for physicians, nurse practitioners, physician assistants, optometrists and dentists to prescribe controlled substances.
Beginning Nov. 1, 2026, the NC Medicaid Direct Pharmacy Benefit Administrator (PBA) will verify that the prescriber has an active DEA number on their NCTracks provider enrollment record before adjudicating claims for controlled‑substances.
Pharmacy claims for controlled substances will be denied if the prescribing provider does not have an active DEA certification on file in NCTracks. This requirement applies based on the claim’s date of service.
Providers who prescribe controlled substances should reference the recently published Action Required: Drug Enforcement Administration Certification Required for Prescribing Controlled Substances bulletin for more information.
Deadline Extended to Oct. 1, 2026, for 251S00000X Providers with No Services Selected
Organizational providers enrolled with taxonomy 251S00000X now have until Oct. 1, 2026, to ensure enrollment with at least one SERVICE-TYPE (column AE on the Provider Permission Matrix (PPM)) and SERVICE (column AF).
Services may be added through the submission of a Manage Change Request (MCR) in NCTracks. Providers enrolled with taxonomy 251S00000X, but no active service must act by this deadline to avoid termination of the taxonomy and potentially the service location and provider record.
To confirm Service-specific requirements, providers should refer to the Provider Permission Matrix (PPM), applicable Clinical Coverage Policies and NCTracks provider guidance.
Behavioral Health Post-Enrollment National Accreditation Reminder
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.
NC Medicaid recently hosted a webinar, “Changes Impacting Behavioral Health Provider Organization Enrollment, Taxonomy 251S00000X,” to inform providers on this issue. The slide presentation and video recording are available on the Provider Playbook: Training Courses webpage.
Additional resources, including FAQs, are located on the Behavioral Health I/DD, Mental Health and Intellectual and Developmental Disabilities (I/DD) webpage.
Off-cycle Provider Reverification Taking Place This Fall for Certain Providers
Per Centers for Medicare & Medicare Services (CMS) notification on April 23, 2026, NC Medicaid is requested to conduct off-cycle, expedited provider reverification with a focus on high-risk providers, including National Provider Identifier (NPI) and atypical providers.
The list of impacted providers will be included on a tab called “CMS_HighRisk_Atypical” in the Active Provider Reverification Report, posted on the Provider Enrollment Recredentialing webpage.
The CMS High Risk Atypical tab includes providers identified as either NPI or atypical who are classified as high categorical risk level and meet one of the following:
- Have not been reverified in the last 12 months.
- Are due within the next 12 months.
The process to initiate this reverification is currently under development, and notifications with specific deadlines for application submission are expected in late September 2026. Impacted providers should monitor their NCTracks secure Provider Message Inbox and email for notifications.
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.
NC Medicaid Webinars
Attending webinars can help providers stay informed about program initiatives and updates. The following webinars are upcoming.
Provider Enrollment Summer and Fall Webinar Series
NC Medicaid’s Provider Operations will host the second webinar in the 2026 series on Sept. 24, 2026, from 12 p.m. -1 p.m.
The session will offer deeper dives on the following subtopics:
- Reverification
- Exclusion Sanction Questions and Disclosures
- Updating Service Locations
- Updating Taxonomies
- Managing Employees
Stay tuned to NCTracks announcements for more information and registration.
Virtual Office Hours
The final quarterly Virtual Office Hours webinar of 2026 will take place on Thursday, Nov. 5, from noon – 1 p.m. This session will share provider enrollment hot topics and offer an interactive format for providers to ask questions.
Connecting Communities & Medicaid (CCM)
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 H.R. 1 and federal changes to Medicaid, including upcoming impacts on eligibility and program operations.
If you are interested in joining, please visit the CCM webpage.
Back Porch Chat
Dr. Brittany Watson, Associate Medical Director Consultant of NC Medicaid, will host an upcoming Back Porch Chat on Nov. 19, 2026.
Visit the Provider Playbook: Training Courses webpage to register for upcoming sessions or view archived presentation slides.
H.R. 1 Information for Beneficiaries
NC Medicaid recently held a Cafecito and Fireside Chat on the upcoming changes to Medicaid. The recordings are available on H.R. 1 website at medicaid.nc.gov/changes and offer a relaxed, informational discussion about what’s next.
Recent Provider Communications
Providers are encouraged to review the following content which has been recently created or refreshed.
NC Medicaid Provider Enrollment Bulletins:
- Provider Categorical Risk Level Adjustment
- Deadline Extended to Oct. 1, 2026, for 251S00000X Providers With No Services Selected
- Reminder: Innovations Waiver Provider Services Updates
- Off-cycle Provider Reverification Taking Place This Fall for Certain Providers
NCTracks Provider Announcements:
- Community Intervention Services Enrollment Updates
- Backup NCTracks Office Administrator Role Available Effective May 17
- Reminders about Required Provider Disclosures Including Expungements and Criminal Traffic Violations
- Update to North Carolina Medicaid Due Process/Appeals Unit Fax Number for Claim Review
- Updates to NC Innovations Waiver Services for Taxonomy 251S00000X
- Reminder: Verify Legal Entity Name Before Submitting Enrollment Applications
- Reminder: Submit Draft Applications to Prevent Loss of Data
- Important Security Update: Email Verification Required to Ensure Receipt of New Authorization Code
NCTracks Frequently Asked Questions:
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