Out-of-State Provider Enrollment

At the request of the Centers for Medicare and Medicaid Services (CMS), effective October 29, 2017, out of state (OOS) providers seeking to enroll with North Carolina Medicaid or NC Health Choice (North Carolina’s name for the Children’s Health Insurance Program) will have the option to use a full-enrollment application or a lite-enrollment application. This new feature was announced over the last several months in the Medicaid Bulletin.

If an OOS provider chooses to enroll using the lite-enrollment application, the following will apply:

• The provider will complete an abbreviated application
• Enrollment is limited to one year
• Credentialing and background checks will be required
• Fingerprint-based criminal background checks, refer to the August 2017 Medicaid Bulletin.
• There is no application fee for lite-enrollment

If an OOS provider chooses to enroll using the full-enrollment application, the following will apply:

• The provider will complete a full-enrollment application
• The provider is required to complete reverification every five years
• Credentialing and background checks will be required
• Fingerprint-based criminal background checks, refer to the August 2017 Medicaid Bulletin.
• The provider will be required to pay the $100 North Carolina application fee during enrollment and reverification

Note: An OOS provider has the option to change from lite enrollment to full enrollment by submitting a Manage Change Request (MCR). The provider will be required to pay the $100 North Carolina application fee.

Existing OOS providers are automatically full enrollment OOS providers because full credentialing was completed for these providers.

A new instructor-led training course for OOS lite-enrollment will be offered beginning November 2017. An announcement will be posted on the Provider Training page of the NCTracks provider portal when the course has been scheduled.