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Ensure Your Information Displays Correctly in NC’s Provider Directory – Medicaid Provider and Health Plan Look-Up Tool

The public version of the Medicaid  Provider and Health Plan Lookup Tool is now available at: https://ncmedicaidplans.gov/. Providers are encouraged to use this tool to confirm the availability and accuracy of information contained in their NCTracks provider enrollment record.

Interim Report to Assist Providers in Verifying Their Records 

The Standard Plan Provider Directory Listing and Affiliation Report (generated Dec. 13, 2024)
and the Tailored Plan Provider Directory Listing and Affiliation Report (generated Dec. 13, 2024)
contains information for all active NC Medicaid individual and organization providers published on the NCEB website and mobile app. More specifically, the report identifies:

  • Primary Care Providers (PCPs) and Specialty providers contracted with a Health Plan and/or Tribal Option
  • NC Medicaid Direct providers who are not participating in managed care
  • Organization affiliation information for individual providers (Affiliated Organization section)
  • Providers slated to be included in the auto-assignment process due to their identification as an Advanced Medical Home (AMH) or PCP contracted provider (SP/TP Managed Care Health Plan sections)

Providers have the opportunity to correct erroneous demographic and affiliation data on their enrollment record in the secure NCTracks Provider Portal using the NCTracks Managed Change Request (MCR) process. A Field Description tab is available on the report to connect the section of the MCR to the field in the report displaying the information. 

If the Affiliated Organization information is incorrect, the Office Administrator for the affiliated individual provider must update the organization affiliation on the individual provider record. Providers unable to find their NPI/location associated correctly with the appropriate Health Plans should reach out directly to the Health Plan to discuss contracting options. Contact information can be found on the Health Plan Contacts and Resources webpage.

Additional information on updating an NCTracks provider record can be found here or by calling the NCTracks Contact Center at 800-688-6696. 

Note: This report combines the information previously offered on the Provider Directory Listing Report and Provider Affiliation Report into one report

Provider Ombudsman

The Division of Health Benefits (DHB) has created a Provider Ombudsman to represent the interests of the provider community by receiving and responding to inquiries and complaints regarding PHPs. The Ombudsman will provide resources and assist providers with issues through resolution.

Additionally, the Ombudsman will assist providers with Health Information Exchange (HIE) inquires related to NC HealthConnex connectivity compliance and the HIE Hardship Extension process.

Provider Ombudsman inquiries, concerns or complaints can be submitted to Medicaid.ProviderOmbudsman@dhhs.nc.gov, or providers may utilize the  Provider Ombudsman line at 866-304-7062. The Provider Ombudsman contact information will also be published in each PHP provider manual.

Practice Support and Technical Assistance

NC Medicaid, in partnership with NC Area Health Education Centers (AHEC), will be providing education and engagement, outreach and practice-level technical assistance to essential practices on transition processes and quality initiatives as NC Medicaid transitions to managed care. This high-level interaction is intended to help Medicaid providers successfully transition to managed care.

The partnership is assisting with webinars, online resources, meet-and-greet events with health plans across the state, virtual office hours and regional-focused training events. More information and resources are available in the Provider Playbook for Medicaid Transformation.
 
This support will also focus on rural and independent practices, including on-site coaching and technical assistance. For questions, email Practicesupport@ncahec.net.

New Primary Care Provider Change Request Form for Members in Managed Care Prepaid Health Plans

In collaboration with primary care providers (PCPs), the NC Medicaid Managed Care Prepaid Health Plans (PHPs) have created a new standardized PCP Change Request Form for members who wish to change their primary care assignment throughout the year. A link to each health plan’s form can be found here:

As a reminder, beneficiaries can change their PCP/Advanced Medical Home (AMH) without cause twice each year. For more information, please see New Primary Care Provider Change Request Form for Members in Managed Care Prepaid Health Plans.

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This page was last modified on 12/16/2024