Recredentialing is an evaluation of a provider’s ongoing eligibility for continued participation in NC Medicaid. The term recredentialing is used interchangeably with reverification and revalidation.
The Affordable Care Act mandates that providers be recredentialed every five years. As part of the process, the provider’s credentials and qualifications are evaluated to ensure they meet program requirements and are in good standing. The re-credentialing process also includes a criminal background check on all owners and managing relationships associated with the provider record.
Providers receive notice of their forthcoming recredentialing due date via the message center inbox in the NCTracks secure provider portal.
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 program 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.