Provider Enrollment Application

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 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).