All providers enrolled in the Medicaid program must complete the reverification application process every five years, as mandated by federal law 42 CFR § 455.414. This process ensures that provider information is accurate and current and includes an evaluation of the provider’s credentials and qualifications to ensure they meet professional requirements and remain in good standing.
Providers are given 70 days from the initial notification date to complete the re-verification application. Although applicable to all providers (but especially those that require fingerprinting and site visit) acting promptly upon receiving the notice allows ample time to complete the process, and when necessary, to resubmit a new application if their original application is denied, withdrawn, or abandoned.
Do not wait to submit. Providers should take advantage of the 70-day timeframe given to ensure completion without adverse action.
Additional reverification reminders to consider:
- Corrections cannot be made to any application once submitted, so any errors or omissions in a reverification application can result in the application being abandoned, denied or withdrawn. Providers who respond early to the reverification notice will have more time to re-submit a new application to correct any mistakes or incomplete data. Providers who wait until their suspension date nears risk suspension and termination.
- Confirm that all active taxonomies are used by the provider. Each service location must have at least one active taxonomy, but some require additional credentials, screenings (i.e. site visit and fingerprinting), or a federal fee as published on the Provider Permission Matrix (PPM). If a taxonomy is no longer in use, end-date it to avoid possible expense and additional screening.
- If your taxonomy is designated as High or Medium Categorical Risk on the PPM, you will be asked whether you have paid the federal fee or had a site visit through Medicare or another state’s Medicaid program. Site visits are required per 42 CFR § 455.432.
- If the fee or site visit was conducted for the name, NPI, and location matching the reverification application being submitted, answer the question “Have you completed the Federal Fee [site visit] for this site to NC Medicaid, another state or Medicare with in the past five years?” affirmatively with the correct response.
- It is crucial to answer these questions correctly to avoid adverse action and delays in processing the application.
- Review each active owner and managing employee (ME), being sure to end-date any who are no longer associated with the individual provider or organization, as background checks are required for everyone who is active on the record.
- The reverification must be completed, and applicable fees paid, by or before 5 p.m. on the due date; otherwise, the provider record will be suspended and claims will pend.
As a convenience, NC Medicaid offers an Active Provider Reverification Report on the Provider Recredentialing webpage. This report is now updated monthly and offers reverification due dates over a period of 12 months. Providers should review the reverification due date list and frequently check their NCTracks Provider Message Inbox for notifications or the reverification section of the Status and Management page in the NCTracks Secure Portal for the option to reverify.
Resources
- NC Medicaid Provider Recredentialing webpage
- NCTracks Provider Recredentialing/Reverification webpage
- NCTracks User Guides & Fact Sheets
Contact
- NCTracks Call Center: 800-688-6696
- Provider Ombudsman: 866-304-7062