Centralized Credentialing Vendor Selected for NC Medicaid

A contract has been awarded to Wipro Infocrossing to serve as the Provider Data Contractor (PDC), as NC Medicaid transitions to Managed Care. Wipro Infocrossing will assist the North Carolina Medicaid Managed Care program to identify the credentialing status of providers contracting with Prepaid Health Plans (PHPs).

To minimize the administrative burden on providers as NC Medicaid transitions to managed care, the PDC will supplement the state’s existing provider credentialing data to support the PHP’s ability to make quality determinations during provider Medicaid Managed Care network contracting activities.

PHPs will rely upon the provider credentialing information to determine if a provider meets the PHP’s quality standards and should be allowed to participate in the PHP’s provider network. This streamlined process will facilitate providers enrolling with a PHP for the first time as well as providers currently participating in NC Medicaid or NC Health Choice.

  1. The PDC will be responsible for obtaining the primary source-verified credentialing data for NC Medicaid and NC Health Choice enrolled providers.
  2. The PDC will not be permitted to reach out to providers to update the provider’s information, though providers are encouraged to keep their credentialing file up to date.
  3. To ensure that PHPs have access to information from a credentialing process that is held to consistent, current standards, the credentialing data will be primary source-verified under the standards of NCQA.
  4. PHPs will be required to accept verified information from the PDC and will not be permitted to require additional credentialing information from a provider to make their quality determination.

As noted in a previous article, Medicaid providers are encouraged to update their enrollment records in the NCTracks provider portal.

  1. Providers should:
  2. Review affiliations by location for accuracy
  3. End-date any affiliations that are not current
  4. Make sure physical addresses are correct with the accurate taxonomies
  5. Review license, certification, and accreditation information
  6. If necessary, begin the Managed Change Request process to make necessary corrections and updates

For assistance, please reference the NCTracks Provider User Guides and Training, Provider Record Maintenance.

Detailed information about the design of North Carolina’s implementation of Medicaid Managed Care is available at https://ncdhhs.gov/NC-medicaid-transformation.