Out-of-State Provider Enrollment

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 NC Health Choice programs. They are only eligible for enrollment under the following conditions:

  • For the reimbursement of services rendered to NC Medicaid or NC Health Choice 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 NC Health Choice, 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.