Enrollee Report Updates for Primary Care Practices
What is the Enrollee Report?
The Advanced Medical Home (AMH) NC Medicaid Direct/Managed Care PCP Enrollee Report identifies NC Medicaid Direct and NC Medicaid Managed Care beneficiaries assigned to primary care providers (PCP) and allows PCPs to know their assigned beneficiaries.
The Enrollee Report is delivered monthly to the NCTracks Secure Provider Portal Message Inbox. It has been in production since March 15, 2021, and the Department has produced various iterations of the report to support PCPs in a Standard Plan, Tailored Plan, NC Medicaid Direct and as of Dec. 8, 2025, the Children and Family Specialty Plan (CFSP). A version of the Enrollee Report that includes Tailored Care Management (TCM) assignment information has been in production since December 2022.
Information Included in the Enrollee Report
The Enrollee Report is a list of all NC Medicaid beneficiaries assigned to the identified PCP in the past 12 months. PCP assignment is made at the practice location level. The list below provides details.
- Recipient name
- Date of birth
- Provider name
- National Provider Identifier (NPI)/Atypical ID
- Service location address (to which the member is assigned)
- Medicaid Identification Number
- Active (Y or N) (currently enrolled in Medicaid and assigned to you)
- Assignment program (i.e. MED-DIR =NC Medicaid Direct, MED-MGD = Medicaid Managed Care, MED-TCM for Medicaid Tailored Care Management)
- PCP Enrollment Start Date
- PCP Enrollment End Date
- Effective date (of assignment)
NOTE: The member list in the enrollee report should not be used as verification of eligibility.
To effectively use the report, add filters or sort the report based on an Active status of “Y.”
This narrows the results to display only those currently enrolled in NC Medicaid and assigned to the identified NPI. Changes to member assignment are always effective the first day of the following month and will be reflected on the new monthly report.
The Enrollee Report includes functionality to identify members’ Medicaid program aid category, assigned health plan, where applicable and TCM provider, as applicable.
How to Check Patient Eligibility/Health Plan Enrollment
The Recipient Eligibility Verification function of NCTracks includes the beneficiary's benefit program and managed care assignment information to allow providers to verify current eligibility and eligibility for the following month.
Always verify coverage and managed care assignment prior to rendering services as prospective eligibility information is subject to change.
What Has Changed About the NC Tracks Recipient Eligibility Response
Tailored Care Manager information, if applicable, is included on the Recipient Eligibility Response page, including the name of the health plan and contact information and the health plan’s assignment for PCP.
Due to carve-out services and the necessity to display other benefit plan information, it is important for providers to give special attention to the Service Types and Copay section under each benefit plan.
| Benefit Plan | What Does it Mean? |
|---|---|
| Children and Families Specialty Plan | Beneficiary is enrolled in CFSP. The health plan is identified along with the dates of enrollment. The Service Types and Copay section identify the services covered and billed to the beneficiary’s health plan. |
| Standard Plan | Beneficiary is enrolled in a Standard Plan. The health plan is identified along with the dates of enrollment. The Service Types and Copay section identify the services covered and billed to the beneficiary’s health plan. |
| NC Medicaid Managed Care Carve-out Plan (MCCRV) | Health plans are not responsible for carved out services. The Service Types and Copay section under this benefit plan identifies carved out services, including dental, frames, lenses, and case management (for children’s developmental services agency (CDSA) services), all of which would continue to be billed through NC Medicaid Direct. See the Health Plan Contracts page for more details on carved out services. |
| Managed Care for Behavioral Health Services | Local Management Entities/Managed Care Organizations (LME/MCOs) provide comprehensive behavioral health services for Medicaid beneficiaries ages 3 and older under the NC 1915(b)(c) Waiver. This benefit plan identifies the LME/MCO entity offering the Service Type identified (Mental Health - Mntl Hlth) and to which these services would be billed. |
| Innovations Waiver | Beneficiary receives services through the Innovations waiver. The health plan is identified along with the dates of enrollment. |
| Traumatic Brain Injury (TBI)Waiver | Beneficiary receives services through the TBI Waiver. The health plan is identified along with the dates of enrollment. |
| Innovations Waiver – CAP Services | Beneficiary is receiving Community Alternatives Program (CAP) services from the LME/MCO. The LME/MCO is identified along with the dates of enrollment. |
| Traumatic Brain Injury Waiver | Beneficiary is receiving TBI services from the LME/MCO. The LME/MCO is identified along with the dates of enrollment. |
| NC Medicaid Direct | Beneficiary remains in the NC Medicaid Direct for the dates specified. The Service Types and Copay section identifies the services covered and billed through NC Medicaid Direct. |
Standard Plans
NC Medicaid will continue to post the Enrollee Report in the NCTracks Provider Message Inbox for NC Medicaid Direct and all health plans. In addition, all PCPs will receive assigned enrollee panel information from each Standard Plan according to information below.
AMHC’s secure provider portal at navinet.navimedix.com offers web-based solutions that allow providers and health plans to share critical administrative, financial and clinical data in one place. This tool can help you manage patient care with quick access to:
- Panel roster reports
- Member eligibility and benefits information
- Care gap reports to identify needed services and preventive screenings
- Member clinical summaries
- Social determinants of health status
- Admission and discharge reports
- Medical and pharmacy claims data
- Electronic submission of prior authorization requests.
Providers can view their current member panel through the secure provider portal at carolinacompletehealth.com.
Information regarding panel management is provided during a provider’s onboarding process.
Providers can access panel reporting from Availity* or contact Provider Services at 844-594-5072 to request a copy (*registration required).
Through Availity, providers can access assigned beneficiary panels in the Availity portal. Sign in and go to the “Payer Spaces” or “Resources” tab to find “Member Panel Listings” or “Provider Online Reporting” to view your panel.
- Log in to the Availity portal.
- Select Payer Spaces from the top navigation.
- Choose the health plan (e.g., Healthy Blue NC).
- From the Payer Spaces home page, click the Resources tab.
- Select Provider Online Reporting and then Member Panel Listings.
- If you don't see "Provider Online Reporting," click Next at the bottom of the page to find it.
To update your primary care practice panel size, contact Healthy Blue Care Together via email at NC_Provider@healthybluenc.com
WCHP's internal systems house panel management information and providers can reach out to their assigned Provider Network Specialist for confirmation of same.
If the provider closes their panel to new members, they can view this in the WCHP online provider directory at provider.wellcare.com
Providers can sign-on to view their panel rosters electronically on the provider portal at uhcprovider.com via a unique username and password.
Tailored Plans
All PCPs will receive assigned enrollee panel information from each Tailored Plan according to the information below.
Providers can view their practice panel size through the Alliance secure provider portal and access their panel size by access ACS and going to Provider Maintenance/Sites/Details/Site primary care practice details.
Providers can update their primary care practice panel size by completing the online PCP Panel Size Update Form.
Information regarding panel management is provided during a provider’s orientation process.
For additional assistance, call Provider Support at 855-759-9700 Monday through Saturday from 7 a.m. – 6 p.m.
PCP practices can request their PCP assignment information by contacting Provider Support at 855-759-9700 Monday through Saturday from 7 a.m. – 6 p.m.
Providers can contact Physical Health Provider Relations and Support team at NetworkRelations@CCH-Network.com or 833-552-3876 to obtain their panel size limits and/or request adjustments to those limits.
For the assigned enrollee panel, providers can use ProviderConnect, Partners’ secure provider portal. For more information visit Partners’ website or call the Provider Services Line at 877-398-4145 Monday-Saturday, 7 a.m.- 6 p.m.
Providers can obtain current panel size limits or update their primary care practice panel size by contacting Carolina Complete Health Provider Relations and Support team at NetworkRelations@CCH-Network.com or call 833- 552-3876.
Contact Provider Support Service Line for additional questions at 855-250-1539 or email NetworkServicesSupport@trilliumnc.org.
Trillium recommends providers utilize reporting through NCTracks for enrollee level information. Enrollee panel reports are available upon request by calling 855-250-1539 or email NetworkServicesSupport@trilliumnc.org.
PCPs can email changes to panel sizes to providerenrollment@vayahealth.com.
The Provider Network team will confirm panel sizes. The PCP panel roster report is available to each PCP via the Vaya Provider Portal and refreshed each month.
All PCPs will receive assigned enrollee panel information from CFSP according to the information below.
Providers can access panel reporting from Availity* or contact Provider Services at 833-777-3698 to request a copy (*registration required).
Within Availity, providers can access assigned member panels in the Availity portal After signing in, navigate to the “Payer Spaces” or “Resources” tab to find “Member Panel Listings” or “Provider Online Reporting” to view your panel.
- Log in to the Availity portal.
- Select Payer Spaces from the top navigation.
- Choose the health plan (e.g., Healthy Blue NC).
- From the Payer Spaces home page, click the Resources tab.
- Select Provider Online Reporting and then Member Panel Listings.
- If you don’t see “Provider Online Reporting,” click Next at the bottom of the page to find it.
To update your primary care practice panel size, contact Healthy Blue Care Together via email at NC_Provider@healthybluenc.com.
Do I Need Authorizations to Provide Primary Care for a Memeber Not Assigned to me?
Beneficiaries do NOT need authorization to see an in-network PCP even if it is not their assigned PCP. PCPs are encouraged to help beneficiaries engage with their assigned practice or help them change their assignment. Beneficiaries WILL need prior authorization to see a PCP who is NOT in network.
How do I Help a Beneficiary Change their Practice Assignment? How Long Before the Change Goes Into Effect?
Providers can request a change to beneficiary assignment without beneficiary approval in certain circumstances. Between Dec. 1, 2025, and June 30, 2026, CFSP beneficiaries can change their PCP for any reason.
PCPs can encourage beneficiaries to call their health plan’s member services phone number (on the back of their Medicaid ID card) to change their PCP.
What if I Have Questions?
- More information on PCP assignment processes and managing common assignment challenges can be found in the Primary Care Provider/Advanced Medical Home Auto-Assignment Guidance.
- Information on CFSP eligibility and enrollment can be found in the Managed Care Claims Submission – What Providers Need to Know Fact Sheet.
- Additional resources for providers on NC Medicaid Managed Care can be found in the NC Medicaid Help Center, Provider Playbook and on the Medicaid Transformation webpage.
- For general provider inquiries and complaints regarding health plans, contact the Provider Ombudsman at Medicaid.ProviderOmbudsman@dhhs.nc.gov or 866-304-7062. The Provider Ombudsman contact information is also published in the health plan’s provider manual.
- For questions related to NCTracks provider information, contact the NCTracks Call Center at 800-688-6696. To update your information, log into the NCTracks provider portal to verify your information and submit an MCR.
This page was last modified on 02/06/2026