Provider Re-credentialing/Re-verification

What is this about?

The Affordable Care Act mandates that all Medicaid Providers must be revalidated every 5 years. This is to ensure that provider information is accurate and current. 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-credentialing process also includes a criminal background check on all owners and managing relationships associated with the provider record.

Is it Re-credentialing or Re-verification?

The terms re-credentialing and re-verification are used interchangeably in NCTracks. Either is acceptable.

How will I know if I need to complete the Re-credentialing application?

You will receive a re-credentialing/re-verification invitation via the NCTracks secure portal when you are scheduled to begin the re-credentialing process.

Note: Providers cannot access the re-credentialing application until they receive an invitation to begin the process.

Is there a fee required?

Effective Jan. 9, 2022, NCTracks no longer requires 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. When applicable, providers maybe required to pay a federal fee. Fees by year may be found in the spreadsheet State and Federal Fee Amounts by Year located under Quick Links on the Provider Enrollment page. Fees must be paid when submitting the re-verification application. Refer to the Provider Permission Matrix on the NCTracks Provider Enrollment page to determine if the federal fee is required. For more information refer to the Federal Fee and NC Application Fee FAQ page.

How Much Time do I have to complete the Re-credentialing process?

Effective April 29, 2018, the provider is given 70 days from the notification date to complete the re-verification application. If the application is not completed within that time frame, the provider record will be suspended and claims will not be paid. The provider will receive a suspension letter via regular mail to the correspondence address on record as well as via the NCTracks message center. If suspended for failure to complete the re-verification/re-credentialing application, the provider will be notified of the date to submit the application by to avoid termination, which will be 50 days after suspension. To continue participation in the North Carolina DHHS program, the provider must complete the re-credentialing application by that date or NCTracks will terminate the DHB and DPH health plans. (The entire record is terminated only if all health plans are terminated.)

Note: The termination date will be printed on the suspension letter.

What happens if I don’t complete the Re-credentialing application?

Your enrollment will be terminated, and you will be required to submit a re-enrollment application if you wish to continue to render services with NC – Medicaid.