Behavioral Health Provider Enrollment FAQs

On April 25, 2016, the Centers for Medicare & Medicaid (CMS) issued final regulations that revise and significantly strengthen existing Medicaid managed care rules.  As a result, 42 CFR 438.608 (b) Provider screening and enrollment requirements, the State, through its contracts with a MCO, PIHP, PAHP, PCCM, or PCCM entity must ensure that all network providers are enrolled with the State as Medicaid providers, consistent with the disclosure, screening and enrollment requirements of CFR 455, subparts B and E.

Effective July 1, 2017, Behavioral Health providers not currently enrolled in NCTracks were required to enroll via the NCTracks Provider Enrollment Online Application. This included providers who did not have an active record in NCTracks as of June 30, 2017 via the Provider Upload process. The Upload process ended at 12:00 a.m. on  June 30, 2017. Effective July 1, 2018, LME-MCO network Behavioral Health providers who have an active record in NCTracks via the Upload process will be required to be re-credentialed via the NCTracks Provider Enrollment Online Re-Credentialing Application.

Effective Jan. 9, 2022, NCTracks will no longer require Medicaid and NC Health Choice providers to pay the $100 NC application fee with enrollment and re-verification applications. This change is made pursuant to NC Senate Bill 105 Session Law 2021-180 Section 9D.9(a), which waives the fee until June 30, 2023.

Section 6401 of the Affordable Care Act (ACA) mandated DHB collect a federal application fee from certain Medicaid and N.C. Health Choice (NCHC) providers. The Centers for Medicare & Medicaid Services (CMS) sets the application fee, which may be adjusted annually. Application fees by year may be found in the spreadsheet titled Federal Fees & NC Enrollment Fees by Year under Quick Links on the Provider Enrollment page. The fee is used to cover the cost of provider enrollment screenings and other program integrity efforts. The application fee will be collected at initial enrollment, re-enrollment, re-credentialing and subsequently when a provider adds a new site location. Initial enrollment is defined as an in-state or border-area provider who has never enrolled to participate in the N.C. Medicaid/Health Choice programs. The provider's tax identification number is used to determine if the provider is currently enrolled or was previously enrolled. Providers initially enrolling or re-enrolling in the N.C. Medicaid or NCHC program who do not pay the fee within 30 days of receipt of invoice will have their applications voided through NCTracks. Providers in border states located within 40 miles of N.C. who have paid the fee to their home state will be required to provide proof of payment.

LME/MCOs were able to submit a PUP for a new provider through June 30, 2017.

In accordance with Title 42 CFR 455.434 and 42 CFR 455.450 ( c ), fingerprint-based background checks are required for all high categorical risk providers and their owners who have a 5% or greater direct or indirect ownership interest as a condition of enrollment in the NC Medicaid and Health Choice Program. Under Medicare regulations at 42 CFR 424.518 (c), newly enrolling home health agencies and newly enrolling Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) suppliers are designated "high"risk. N.C.G.S 108C-3 further defines providers that are impacted in North Carolina. For more information, see the Fingerprinting FAQ page.

No, per NCGS 108C-9 Providers are only required to attend training prior to being intially enrolled.

Re-verification is sometimes referred to as re-credentialing or re-validation. These words are used interchangeably. This process is required every five years. As part of this process, the provider’s credentials and qualifications will be evaluated to ensure they meet the professional requirements and are in good standing. The re-verification process also includes a criminal background check on all owners and managing relationships associated with this provider record.

 

Effective Jan. 9, 2022, NCTracks will no longer require Medicaid and NC Health Choice providers to pay the $100 NC application fee with enrollment and re-verification applications. This change is made pursuant to NC Senate Bill 105 Session Law 2021-180 Section 9D.9(a), which waives the fee until June 30, 2023. Providers may also be subject to the ACA fee if applicable. Application fees by year may be found in the spreadsheet titled Federal Fees & NC Enrollment Fees by Year under Quick Links on the Provider Enrollment page.

 

A re-verification application will appear when it is time to re-verify. Until then, the Re-verification section will read No Data to Display. On-going verification only occurs when a provider license or certification is about to expire. Forty-five days before the provider accreditation or license expires, CSRA will send the provider a notice to complete a Manage Change request to update the accreditation or license information. On-going verification is completed using the Manage Change Request application. When completing on-going verification, the provider will simply start a new MCR application and update the license # or expiration date. Some licenses or certifications expire annually.

 

With the planned implementation of Nov. 1, 2017, a provider will be required to complete a Maintain Eligibility application if they does not submit claims within a twelve-month period. This process is used to verify that the provider record is still active. When a provider has not billed claims within twelve months, CSRA will send the provider a notification in the messaging center asking the provider if he/she wishes to remain active. If the provider does not complete the Maintain Eligibility application, the provider record will be terminated. If the provider is terminated, he/she will be required to complete a re-enrollment application to participate in the North Carolina Medicaid program.

A new User Guide has been posted that provides step-by-step instructions for adding or updating accreditations on a provider record.  It can be found on the Provider User Guides and Training page of the NCTracks Provider Portal under the heading "Provider Record Maintenance."

No. Adding a taxonomy code may require verification of provider credentials.

The Office Administrator (OA) is the person who will assign security roles for your provider entity. State Policy requires the OA be an owner or some other individual who has managing authority for the provider or provider entity. An OA is required for accessing the NCTracks Provider portal. The OA must have an NCID (North Carolina Management Identifier) to access the Provider Portal. The portal allows providers to access eligibility information, inquire on claim status, submit claims, and obtain their remittance advices.

Effective July 1, 2017, Behavioral Health providers who are requesting initial enrollment through a LME/MCO will be required to enroll via NCTracks. LME/MCO credentialing is independent of provider enrollment/credentialing via NCTracks.

Effective 7-1-17, LME/MCOs can amend provider records that are active in NCTracks.  

LME/MCOs will continue to receive the data they are currently receiving.

Yes, there are no plans to change the existing process.

Neither.  It is the effective date requested by the provider.

The agency name and NPI# should be entered in NCTracks not the unlicensed AFLs and Therapeutic Foster Care homes.

No.  Effective July 1, 2017, the Notice of LME-MCO Credentialing/Re-credentialing Action Form is no longer required.