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NC Department of Health and Human Services
NC Division of
Medical Assistance
 
 

Provider Enrollment

The Division of Medical Assistance recognizes the need to promote access to care by enrolling all providers in a timely manner and is committed to ensuring the provision of quality care for our citizens. The enrollment process includes credentialing, endorsement, and licensure verification to ensure that all providers are in good standing in the community.

Applicants must meet all program requirements and qualifications for which they are seeking enrollment before they can be enrolled as a N.C. Medicaid and/or N.C. Health Choice provider. Specific qualifications for each provider type are listed in the Provider Qualifications and Requirements Checklist.

Effective July 1, 2013, N.C. Medicaid and N.C. Health Choice providers must enroll using the Online Provider Enrollment Application on the website for NCTracks, the new multi-payer Medicaid Management Information System for the N.C. Department of Health and Human Services (N.C. DHHS) located at https://www.nctracks.nc.gov/content/public/providers/provider-enrollment.html.

Providers are not guaranteed a retroactive effective date and are strongly encouraged to provide services only after they are enrolled as a Medicaid and/or Health Choice provider. However, DMA will consider specific requests for retroactive effective dates if a recipient has been granted retroactive eligibility, an emergency service was provided, or medically necessary services were rendered and the provider's credentials, licensure, certifications, etc. were active and in good standing for the earliest requested date of service.

DMA cannot provide special consideration for processing of enrollment applications due to provider error, incomplete information, or due to a delay in obtaining credentialing, endorsement or licensure information from another agency.

While the provider enrollment application is designed to be completed by a provider with minimal assistance, if assistance is needed, please contact CSC:

Telephone Information:

NCTracks Call Center:

  • Main Call Center Number: 1-800-688-6696
  • Provider Enrollment: 1-800-688-6696

NCTracks Fax Numbers:

  • Main Fax Number: 919-851-4014

Mailing Information:

General Correspondence:
CSC
P.O. Box 300009
Raleigh, NC 27622-8009

Provider Enrollment Supplemental Information:
CSC
P. O. Box 300020
Raleigh, NC 27622-8020

Courier Deliveries – UPS or Federal Express:
CSC
[Name of CSC Employee or Department]
Suite 102
2610 Wycliff Road
Raleigh, NC 27607-3073

More CSC Contact Information

Enrollment, Re-enrollment and Re-credentialing Fees

Affordable Care Act (ACA) Application Fee

October 1, 2012, the N.C. Division of Medical Assistance (DMA) began collecting the federal application fee required under Section 1866(j)(2)(C)(i)(l) of the Affordable Care Act (ACA) from certain Medicaid and N.C. Health Choice (NCHC) providers.

The Centers for Medicare & Medicaid Services (CMS) set the application fee, which may be adjusted annually. The application fee for enrollment in calendar year 2014 is $542.The fee is used to cover the cost of screening and other program integrity efforts.

The application fee will be collected per site location prior to executing a provider agreement from an initial or re-enrolling provider.

This requirement does not apply to the following providers:

     (1) Individual physicians or non-physician practitioners
     (2) (i) Providers who are enrolled in either of the following categories:
              (A) Title XVIII of the Social Security Act (“Health Insurance for the Aged and Disabled”); or,
              (B) Another State's Medicaid or Children’s Health Insurance Program plan
          (ii) Providers who have paid the applicable application fee to:
              (A) A Medicare contractor; or
              (B) Another State

Providers who are required to pay this fee will be sent an invoice via mail. States must collect the applicable fee for any initial or re-enrolling provider.

Providers newly enrolling or re-enrolling in the N.C. Medicaid or NCHC program that do not pay the fee within 30 days of receipt of invoice will have their applications voided by CSC. Providers in border states located within 40 miles of N.C. who have paid the fee to their state will be required to provide proof of payment.

North Carolina Enrollment Fee

Session Law 2011-145 Section 10.31(f)(3) mandated that DMA collect a $100 enrollment fee from providers upon initial enrollment with the Medicaid/Health Choice programs, upon program re-enrollment and at three-year intervals when the providers are re-credentialed.

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.

Applicants should not submit payment with their application. Upon receipt of the enrollment application, an invoice will be mailed to the applicant if either fee is owed. An invoice will be issued only if the tax identification number in the enrollment application does not identify the applicant as a currently enrolled Medicaid and N.C. Health Choice provider.

Providers newly enrolling or re-enrolling in the N.C. Medicaid or NCHC program that do not pay the fee within 30 days of receipt of invoice will have their applications voided by CSC. Providers who are submitting a re-credentialing application and do not pay the fee within 30 days of receipt of invoice may see an interruption in payment.

With the new NCTracks system, providers submitting applications for either enrollment or re-credentialing are automatically linked from the Provider Portal to the secure PayPoint website to pay the required fee using a credit card or one-time automated bank draft (e-check). Once the transaction is completed, a confirmation email is sent to the provider.

Requests for Medicaid enrollment, reenrollment or recredentialing will not be processed unless the payment is received. Applications will be held for up to 30 days. After 30 days, applications will be voided if payment has not been received.

Screening and Training

Beginning October 1, 2012, the N.C. Division of Medical Assistance (DMA) implemented Federal regulations 42 CFR 455.410 and 455.450 – requiring all participating providers to be screened according to their categorical risk level. These screenings will take place both upon initial enrollment and re-enrollment.

42 CFR 455.450 establishes the following three categorical risk levels for N.C. Medicaid and N.C. Health Choice (NCHC) providers to assess the risk of fraud, waste, and abuse:

  • Low
  • Moderate
  • High

Provider types and specialties that fall into the moderate- and high-risk categories are subject to a pre-enrollment site visit, unless a screening and site visit has been successfully completed by Medicare or an appropriate State agency within the previous 12 months. Session Law 2011-399 §108C-3 further defines provider types that fall into each category.

This requirement does not apply to the following providers:

      (1) Individual physicians or non-physician practitioners
      (2) (i) Providers who are enrolled in either of the following categories:
                (A) Title XVIII of the Social Security Act (“Health Insurance for the Aged and Disabled”)
                (B) Another State's Medicaid or Children’s Health Insurance Program plan
           (ii) Providers that have paid the applicable application fee to:
                (A) A Medicare contractor; or
                (B) Another State

North Carolina Senate Bill 496 108C-9.c also requires that – prior to initial enrollment in the N.C. Medicaid or NCHC programs – an applicant’s representative shall attend trainings as designated by DMA, including, but not limited to, the following:

    • The NCTracks Provider Claims and Billing Assistance Guide, common billing errors, and how to avoid them.
    • Audit procedures, including explanation of the process by which the DMA extrapolates audit results.
    • Identifying Medicaid recipient fraud.
    • Reporting suspected fraud or abuse.
    • Medicaid recipient due process and appeal rights.

This training is completely Web-based and will be available online.

It is imperative that providers submit their application with a valid email address that is frequently checked. Providers will be notified via email when it is time to complete the training and the steps necessary to complete the training. 

ATTENTION: BEHAVIORAL HEALTH PROVIDERS: 

As a reminder, NCHC providers must still enroll directly with DMA/CSC, regardless of whether or not these providers accept Medicaid. This also applies to providers billing Medicaid for children aged 0-3,  as children these ages are not covered by the LME-MCO waiver at this time. Most new behavioral health providers are considered Moderate or High risk and should expect pre-screening. More information will be forthcoming regarding procedures for providers enrolling both through DMA/CSC and the LME-MCOs.

Provider Recredentialing

On behalf of DMA, CSC must re credential active Medicaid and Health Choice providers a minimum of every three years 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 that they continue to meet N.C. Medicaid and/or N.C. Health Choice guidelines for enrollment in the program.  The recredentialing process also includes a criminal background check.

CSC will recredential providers in cycles.  Providers will receive a Recredentialing Invitation via their NCTracks secure portal inbox or e-mail when they are scheduled to begin the recredentialing process.  Instructions for accessing the recredentialing application will be sent along with the Recredential Invitation.  Providers cannot access the recredentialing application until they receive an invitation to begin the process.

For more information on recredentialing, visit the "Provider User Guides and Training" web page in NCTracks, and click on the bullet which reads: "How to Complete the Re-Credentialing, Re-Verification Process in NCTracks" under "Enrollment and Verification."

Frequently Asked Questions


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CSC EVC Call Center

Where can I find more information about the new enrollment/credentialing processes?

You can obtain information from the DMA website, as well as from the CSC NC Tracks Website.

Enrollment Applications

Where can I access applications for new enrollments?

The online applications for enrollment as a Medicaid provider and as a Carolina ACCESS provider are available on CSC's NC Tracks Provider Enrollment web page.

Providers also use the online applications to re-enroll, report a change of ownership, report a change of group name/tax name, and to report a change in tax number or to add services.

Enrollment Process

How will I know that my application has been received?

The receipt of your application will be acknowledged by e-mail or in writing.

How will incomplete applications be processed?

Whenever possible, CSC will communicate via e-mail if missing or additional information is needed from providers.

How will I be notified once I am enrolled?

Once you have been approved for participation in the N.C. Medicaid and N.C. Health Choice programs, you will receive a Welcome Email.

Credentialing and Verification

As a currently enrolled provider will I be required to complete a new or additional enrollment application?

No. However, each provider must verify information in the Medicaid provider file and furnish additional information on ownership and criminal background as required by federal and state regulations. CSC will notify each provider prior to initiating the verification and credentialing process and will request providers to complete and return the forms within 30 days.

Will DMA allow providers who that are credentialed by other agencies to be grandfathered and avoid credentialing by CSC?

No. DMA has determined that other credentialing agencies do not collect all required information needed to satisfy all federal and state requirements for Medicaid enrollment. Since CSC will source verify the credentials of providers, providers will not be required to submit copies of licenses, certifications, accreditations or endorsements.

Enrollment Fee

Why am I being charged an enrollment fee?

Session Law 2009-451 mandates that DMA charge an enrollment fee of one hundred dollars ($100.00) to each provider enrolling in the Medicaid program. The enrollment fee must be collected from providers enrolling in NC Medicaid on or after September 1, 2009.

Does the enrollment fee apply to all providers? Is anyone exempt?

  • N.C. Medicaid provider applicants who have never enrolled in the N.C. Medicaid Program, as identified by their tax identification number (SSN or EIN), are required to pay an enrollment fee upon initial enrollment.
  • Active, enrolled providers are required to pay an enrollment fee when they are re-credentialed (approximately every three years).
  • Providers who have been terminated from the N.C. Medicaid Program and wish to have their provider number reactivated or reinstated are required to pay the enrollment fee.
  • Out-of-state providers are excluded from paying the Medicaid enrollment fee.
    (Note: Border-area providers are considered in-state providers and are subject to the fee.)
  • Providers to be enrolled under special circumstances (abbreviated enrollments, atypical enrollments) are subject to the enrollment fee unless they are an out-of-state provider.

As a Community Intervention Services (CIS) provider, am I required to pay an enrollment fee for each service I offer?

If you are a CIS provider offering multiple services under the same tax identification number (SSN or EIN), you are only required to pay only one enrollment fee of $100.00. You are not required to pay an enrollment fee for each service provided.

Do I have to pay an additional enrollment fee to apply as a Carolina ACCESS or Community Alternatives Program (CAP) provider?

If you are a Medicaid provider applicant applying for participation in Carolina ACCESS or CAP under the same tax identification number (SSN or EIN), you are only required to pay one enrollment fee of $100.00.

I would like to provide Medicaid services at multiple locations. Do I have to pay an enrollment fee for each location?

If you are providing services under the same tax identification number (SSN or EIN) , you are only required to pay one enrollment fee of $100.00.

What happens if I don't pay the enrollment fee?

Applications will be held for 30 days. If payment is not received after 30 days, the application will be voided.

Any checks returned as non-payment will be assessed a $25.00 penalty fee and interest as provided for under the Statewide Cash Management Plan (Authority: NCGS: 147-86.21 and 147-86.23 and G.S.105-241).

PLEASE UNDERSTAND THAT PAYMENT OF THE ENROLLMENT FEE DOES NOT GUARANTEE ACCEPTANCE INTO THE NORTH CAROLINA MEDICAID PROGRAM.

Is the enrollment fee a one-time fee or will I have to pay additional fees to maintain my participation in the N.C. Medicaid Program?

On behalf of DMA, CSC will re-credential all active N.C. Medicaid providers approximately every three years. Session Law 2009-451 mandates that we collect a $100 fee at re-credentialing.

Is there a fee for change requests?

There is no fee for processing most provider change requests; however, for a change of ownership, you are required to complete a new enrollment application, which is subject to the Medicaid enrollment fee.

 

 

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