NCTracks
Responding to Re-credentialing Invitations
The Centers for Medicare & Medicaid Services (CMS) requires that all Medicaid providers are revalidated (re-credentialed) at least every five years. This is to ensure that provider enrollment information is accurate and current. The provider’s credentials and qualifications will be evaluated to ensure that they meet professional requirements and are in good standing. The re-credentialing process also includes criminal background checks on all owners and managing relationships associated with the provider record.
Every active NCTracks provider must be re-credentialed. Providers will receive a re-credentialing/reverification letter, or an invitation, through their NCTracks secure portal in-box or e-mail, when they are scheduled to begin the re-credentialing process. This process is completed in the “Status and Management� section of the NCTracks Provider Portal under the section titled “Reverification.� A reverification application will only appear when it is time to reverify. Providers are required to pay a $100 application fee for re-credentialing/reverification.
Providers should follow the instructions in the letter to complete the process.
Re-credentialing is not optional. It is crucial that all providers who receive a notice promptly respond and begin the process. Providers will receive a notification letter 45 days before their re-credentialing due date. If the provider does not complete the process within the allotted 45 days, payment will be suspended until the process is completed. The provider will also receive a termination notice.
If the provider does not complete the re-credentialing process within 30 days from payment suspension and termination notice, participation in the N.C. Medicaid and Health Choice programs will be terminated. Providers must submit a re-enrollment application to be reinstated.
Note: Providers must thoroughly review their electronic record in NCTracks to ensure all information is accurate and up-to-date and take any actions necessary for corrections and updates.
Re-credentialing applies to providers who are enrolled for an indefinite period of time. It does not apply to any time-limited enrolled providers such as Out-of-State (OOS) providers. OOS providers must continue to complete the enrollment process every 365 days.
For more information, see the Provider Re-credentialing/Re-verification webpage on the NCTracks Provider Portal.
[This article was previously published in the Medicaid Bulletin.]