What Providers Need to Know
Re-credentialing, also referred to as re-verification or re-validation, is a required process for most NC Medicaid providers. While the terminology may vary, the purpose is the same: to make sure providers continue to meet the requirements to participate in the NC Medicaid program.
Below is a comprehensive overview of what re-credentialing involves, key deadlines, common pitfalls, and answers to frequently asked questions.
What Is Re-Credentialing?
Re-credentialing is a mandatory process that occurs every five years for enrolled NC Medicaid providers. During this process, NC Tracks evaluates a provider’s credentials and qualifications to confirm continued eligibility.
As part of re-verification, NC Tracks also conducts criminal background checks on all owners and managing relationships associated with the provider’s record. Depending on the provider’s risk level and screening history, additional requirements may apply, such as fingerprinting, a site visit, or payment of a federal enrollment fee.
How and When Will I Be Notified?
Providers are notified through their NC Tracks secure portal Provider Message Inbox when they are scheduled to begin the re-verification process.
The re-credentialing notification letter appears in the Message Center Inbox with the ID PM16000-R0053, described as “Re-verification Letter.” Providers are strongly encouraged to read all messages in the inbox thoroughly and regularly.
How Much Time Do Providers Have to Complete Re-Credentialing?
Providers have 70 calendar days from the initial notification date to submit their re-verification application.
The application must be submitted and all applicable fees paid by or before 4:00 p.m. on the due date listed in the notification. If the deadline is missed:
- The provider record will be suspended
- Claims will pend
- A suspension notice will be sent via regular mail and the NC Tracks Message Center
Delaying submissions is risky. Once an application is submitted, no corrections can be made. Errors or omissions may result in denial. Providers do have the option to withdraw an application with errors, but those who respond promptly to the initial notice have enough time to resubmit correctly.
Waiting until suspension occurs places the provider at risk of termination, at which point re-enrollment is required to continue participation in NC DHHS programs.
Who Is Required to Complete Re-Credentialing?
All actively enrolled providers must complete re-verification through NC Tracks, with one exception: providers enrolled exclusively with Department of Mental Health (DMH)–only health plans.
Providers offering DMH state-funded services will be required to enroll with Medicaid when re-verification is due with their LME/MCO.
Can I Update My Provider Record During Re-Verification?
Yes. Providers do not need to submit a Manage Change Request (MCR) before starting re-verification. Required updates, such as accreditation, certification, or license information, can be completed during the re-verification application itself.
However, providers should note:
- Only one pending application per NPI is allowed
- Providers should not start an MCR when the re-verification option is available
- Any additional updates should be made through an MCR after re-verification is complete
If an MCR is already reviewing and blocking access to re-verification, providers may need to withdraw the MCR and complete re-verification instead, depending on the due date.
What Does Re-Credentialing Cost?
North Carolina law requires all providers to pay an application fee at enrollment and re-credentialing. Every five years, providers must pay:
- The federally required enrollment fee, plus
- A $100 NC application fee
Both fees are non-refundable, even if the application is denied, withdrawn, or abandoned.
Depending on provider risk level and screening history, additional requirements may include fingerprinting or a federal site visit.
What If My Application Is Denied, Withdrawn, or Abandoned?
- The $100 NC application fee is non-refundable
- The federal fee is also non-refundable
However, providers who previously paid the federal fee or completed a federal site visit may be able to avoid repeating those steps if they submit proper documentation with a new application.
If a re-verification application is denied, all NC DHHS health plan enrollments terminate. Providers may re-enroll and request an effective date adjacent to termination (up to 365 days retroactive) to prevent a gap in participation.
Who Can Complete the Re-Verification Application?
The application may be completed by:
- An Office Administrator (OA)
- A Managing Relationship (MR) user
- A designated Enrollment Specialist (ES)
User role details are available in the NC Tracks Office Administrator and User Setup & Maintenance FAQs.
Can Providers Continue Billing During Review?
Yes. If the provider is currently active and the re-verification application has been submitted by the due date and is in review status, providers may continue to bill and receive payment.
Providers should closely monitor the NC Tracks secure Provider Message Inbox for requests for additional information.
Requests for Additional Information
If NC Tracks needs more documentation, a request will be sent through the Provider Message Inbox. Supporting documents can be uploaded:
- At the end of the application via the Upload Documents page, or
- After submission using the Upload link on the Status and Management page while the application is pending
If transcripts or education verification are required, instructions will be provided directly by NC Tracks.
Name Mismatches and Common Errors
The name listed in the NC Tracks Identifying Information section must exactly match:
- The legal name
- The NPPES Registry name
- Any required license, certification, or accreditation
If there is a mismatch, do not submit the application. Instead, email NCTracksprovider@nctracks.com with the required documentation to request a correction.
What Happens If Re-Credentialing Is Not Completed?
Failure to complete re-verification results in termination from all NC DHHS health plans. Providers must then submit a full re-enrollment application to regain participation.
If you need help with North Carolina re-credentialing, you can meet with one of our agency specialists here!
