Provider Enrollment

Applications

NCTracks Provider Enrollment provides the online application and a checklist for provider qualifications and requirements.

  • Providers must provide services only after they are enrolled as an NC Medicaid or NC Health Choice (NCHC) provider.
  • Providers must submit their applications with a valid email address.
  • Application receipts will be acknowledged by email or by mail.
  • NC Medicaid or CSRA will communicate by email if missing or additional information is needed from providers.

NC Medicaid will consider specific requests for retroactive effective dates if:

  • A customer has been granted retroactive eligibility
  • An emergency service was provided
  • Medically necessary services were rendered and the provider's credentials, licensure, certifications, etc., were active and in good standing for the earliest effective date of service

NC Medicaid cannot provide special consideration for processing of enrollment applications due to provider error, incomplete information, or due to a delay in obtaining credentialing, endorsement or licensure information from another agency.

Public Consulting Group (PCG) is contracted by NC Medicaid to perform the federally mandated screening of Medicaid providers classified as moderate and high-risk (reference 42 CFR 455 Subpart E and NCGS 108C).  PCG is also contracted to conduct our online training component (NCGS 108C-9).

Recredentialing

Providers are required to recredential every five years, using the online process in NCTracks, to continue Medicaid program participation. The first notification is sent to the provider’s Message Center Inbox 70 days prior to the provider re-credentialing due date.

Active Provider Recredentialing Due - August - December 2019

Providers who do not complete the recredentialing process on time will be suspended from Medicaid program participation. If the re-credentialing application is not submitted, reminders will be sent at 50 days, 20 days, and 5 days prior to the provider re-credentialing due date. Providers will be suspended if the re-credentialing application is not submitted by their re-credentialing due date. The provider will be terminated from the NC Medicaid and NCHC programs following 50 days of suspension.

NC law requires that providers pay a $100 fee for Medicaid recredentialing.

Note that recredentialing does not apply to time-limited enrolled providers, such as out-of-state providers. Out-of-state (OOS) providers must complete the enrollment process every 365 days. For additional information, please visit the Provider Re-credentialing/Re-verification page on the NCTracks Provider Portal.

Out-of-State Provider Enrollment

Out-of-State (OOS) providers are required to adhere to all NC rules, regulations, laws and statutes governing healthcare delivery under the NC Medicaid and the NCHC programs. They are only eligible for enrollment under the following conditions:

  • For the reimbursement of services rendered to NC Medicaid or NCHC beneficiaries in response to emergencies or if travel back to NC would endanger the health of the eligible beneficiaries;
  • For reimbursement of a prior-approved non-emergency service; or
  • For reimbursement of medical equipment and devices that are not available through an enrolled provider located within NC or in the 40-mile border area.

Effective Oct. 29, 2017, OOS providers who are seeking to enroll with NC Medicaid or the Children's Health Insurance Program (CHIP), also known as NCHC, have the option to enroll using a full-enrollment application or a lite-enrollment application.

If an OOS provider chooses to enroll using the lite-enrollment application, the following will apply:

  • The provider will complete an abbreviated application
  • Enrollment is limited to one year
  • Credentialing and background checks will be required
  • Fingerprint-based criminal background checks, if applicable
  • There is no application fee for lite-enrollment

If an OOS provider chooses to enroll using the full-enrollment application, the following will apply:

  • The provider will complete a full-enrollment application
  • The provider is required to complete re-verification every five years
  • Credentialing and background checks will be required
  • Fingerprint-based criminal background checks, if applicable
  • The provider will be required to pay the $100 NC application fee during enrollment and re-verification

Note: A provider has the option to change from lite enrollment to full enrollment by submitting a Manage Change Request (MCR). The provider will be required to pay the $100 NC application fee.

Providers with questions about the NCTracks online enrollment application can contact the CSRA Call Center at 800-688-6696; 919-851-4014 (fax), or NCTracksprovider@nctracks.com.