Provider Credentialing

NC Medicaid is establishing a Credentialing Committee to review practitioner files that contain flagged items for disposition of their enrollment, reenrollment and recredentialing applications plus ongoing monitoring for all NC Medicaid, Division of Mental Health, Developmental Disabilities and Substance Use Services (DMH/DD/SUS), Division of Public Health (DPH), Office of Rural Health (ORH) and NC Medicaid Managed Care health plans.

The Credentialing Committee will be comprised of voting and non-voting members from the above payers and plans and will meet weekly to review flagged providers. The tentative launch date for the Credentialing Committee is Fall 2025. Visit the Credentialing Committee webpage for more information.

NC Medicaid is also implementing a process to delegate credentialing to major hospitals and large health care systems that will use National Committee for Quality Assurance (NCQA), federal and state guidelines to perform credentialing activities for their health care practitioners. This process is meant to prevent provider abrasion from completing credentialing with multiple payers. The tentative launch date for Delegated Credentialing is Spring 2026. Visit the Delegated Credentialing webpage for more information.