NCTracks Changes to Provider Verification Process

<p>NC Medicaid is making system modifications that will start the process of 45 and 60 day notifications of suspension if a provider fails to update their credential prior to the expiration date.&nbsp;</p>

Currently, NCTracks sends notifications for expiring credentials (licenses, certifications and accreditations) to all enrolled providers required to be licensed, certified and/or accredited. These notices are sent to the Provider Message Center Inbox beginning 60 days in advance of the expiration date of the credential.  

Effective May 9, 2021, NC Medicaid is taking additional steps to ensure providers meet their contractual obligation and responsibility to keep credentials current on their NCTracks enrollment record by making system modifications to begin a process of 45 and 60 day notifications of suspension if a provider fails to update their credential prior to the expiration date on file with NCTracks. Providers were first informed of this forthcoming system modification in March of 2018. 

Choosing from providers with complete and up-to-date licensure, certification and accreditation information allows NC Medicaid beneficiaries to make the informed choices to achieve the best health outcomes. System modifications alerting providers to update expiring credentials will assist providers in meeting federal and State enrollment and credentialing requirements and will assist NC Medicaid in removing unlicensed providers and expired credentials from provider records. With updated provider information, NC Medicaid will be able to transmit accurate provider data to health plans and other departmental partners who serve Medicaid beneficiaries.   

Timeline for notifications, suspension and termination

  • The first notification will be sent 60 calendar days prior to the expiration date of the credential on file with NCTracks. The letter will be sent to the Message Center Inbox with the subject ‘Provider Re-certification Letter’.
  • If the credential is not updated, a reminder notification will be sent at 30 calendar days, and again at 14 calendar days prior to the expiration of the credential. 
  • The final reminder is sent seven calendar days prior to expiration date.

When the credential expires

  • The taxonomy codes that require the expired credential will be suspended if the credential has not been updated by the expiration date.
  • A suspension letter will be generated and sent to the Message Center Inbox with the subject ‘Recertify Suspension Letter’. 
  • The suspension will remain in place for another 60 calendar days, unless the credential is renewed and submitted, in which case the suspension will be lifted. 
  • Note: Suspension means your claims will pend and will not pay until the suspension is lifted.
  • The provider's taxonomy code(s) that requires the expiring required credential will be terminated on the 61st calendar day following suspension. If the terminated taxonomy represents the only taxonomy for that location or provider record, then the service location or enrollment record will also terminate.
  • If you are terminated, you must reapply to participate in the Medicaid and NC Health Choice programs and will not receive payment through NCTracks or our other vendors.

Expired Credentials

For providers with credentials on file that have already expired, the timeline for notification, suspension and termination is as follows: 

  • Due to the number of providers impacted, the providers with expired credentials will be categorized into groups. The first group will receive notifications beginning May 10, 2021.
  • First notification letters will be sent to the Message Center Inbox on the staggered dates with the subject ‘Notification for Re-certification Letter – Expired’
  • If, after 45 calendar days from the original notice day, a provider has not updated the expired credential(s), the taxonomy code associated with the credential will suspend. A suspension letter will be sent to the Message Center Inbox with the subject ‘Suspension for Re-certification Letter – Expired’.
  • An additional 30 calendar days will be given after suspension to update the credential. Thirty calendar days after the suspension date, the taxonomy will terminate if the credential has not been updated. If the terminated taxonomy represents the only taxonomy for that location or provider record, then the service location or enrollment record will also terminate.

Contact

NCTracks Call Center; 800-688-6696 or NCTracksprovider@nctracks.com

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