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.
Currently, if a provider does not complete the re-verification process, or the re-verification application is denied due to a negative background finding, failure to complete fingerprinting, bad data, or expired credentials (license/accreditation/certification per the Provider Permission Matrix), only the provider’s non-Division of Mental Health, Developmental Disabilities and Substance Use Services (DMH/DD/SUS) health plans terminate.
Effective May 19, 2024, an update to NCTracks will be made to the re-verification process. If a provider’s Medicaid health plan is terminated during the re-verification process, their DMH/DD/SUS health plans will also terminate.
Providers will be required to submit a re-enrollment application to continue to render services to NC Medicaid or State-funded beneficiaries.
More information about the re-verification process and links to training documents can be found on the Provider Re-Credentialing/Re-verification page.