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NC Division of Medical Assistance |
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Clinical Coverage Policies and Manuals
Reporting a Change in Provider Status
Zip Codes within 40 miles of the NC Border
The N.C. Medicaid Program 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 Medicaid provider. Specific qualifications for each provider type are listed in the Provider Qualifications and Requirements Checklist.
Providers may enroll using the Online Provider Enrollment Application or by downloading the Provider Enrollment Application in Adobe PDF format.
Once participation as a Medicaid provider has been approved, providers are assigned a Medicaid Provider Number with an effective date and are notified by mail. Providers may begin submitting claims to Medicaid upon receipt of their Medicaid Provider Number.
Providers are not guaranteed a retroactive effective date and are strongly encouraged to provide services only after they are enrolled as a Medicaid 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:
On behalf of DMA, CSC is currently carrying out a 12-month process to verify provider information and conduct credentialing activities for enrolled Medicaid providers. DMA and the N.C. Attorney General's Office have completed an evaluation of provider comments and have revised the Medicaid Provider Administrative Participation Agreement.
Those providers who deferred the completion of the Medicaid Provider Administrative Participation Agreement that was included in the verification packet may now access the revised Agreement on the NC Tracks Website.
Providers who included a completed Agreement with the verification packet and providers who have enrolled for participation with N.C. Medicaid within the last 12 months do not need to resubmit an Agreement. CSC, N.C. Medicaid’s contractor for provider enrollment, verification, and credentialing, will contact you when a new Agreement is required. However, any provider can opt to complete and submit the Agreement before they are notified.
Providers should submit the completed Agreement to CSC by mail, fax, or e-mail as soon as possible to meet the September 1, 2010, deadline for submission.
A $100 enrollment fee is collected from providers upon initial enrollment with the N.C. Medicaid Program and at 3-year intervals when the provider is 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 Program. The provider's tax identification number is used to determine if the provider is currently enrolled or was previously enrolled.
Upon receipt of your enrollment application, CSC will mail an invoice to you for the fee. You will only receive an invoice if the tax identification number on your application does not identify you as a currently enrolled Medicaid provider.
Payment is accepted by check or money order made payable to the N.C. Division of Medical Assistance. Requests for Medicaid enrollment will not be processed unless the payment is received. Payment is due immediately upon reciept of invoice. Applications will be held for up to 30 days. After 30 days, applications will be voided if payment has not been received.
Beginning February 1, 2008, all submitted provider enrollment applications must contain a signed Letter of Attestation. Providers will be notified by email, telephone, or written correspondence if a Letter of Attestation or a new provider enrollment application must be submitted.
What is the EVC Call Center?
CSC is the entity that has assumed the Medicaid provider enrollment, verification, and credentialing (EVC) activities previously performed by DMA Provider Services.
The EVC Call Center is CSC's dedicated Medicaid provider enrollment, verification, and credentialing center for providers to inquire on the status of their Medicaid applications or change requests. The Call Center staff also assists providers with questions regarding completion of enrollment and change forms.
How can I contact the EVC Call Center?
The EVC Call Center hours of operation are 8:00 a.m. to 5:00 p.m., Monday through Friday, except for State-approved holidays.
You may contact the EVC Call Center as follows:
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.
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.
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 Program, you will receive a Welcome Letter from HP Enterprise Services.
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.
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 for the first time. 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?
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.
How will I know if I must pay the fee?
Upon receipt of your enrollment application, an invoice for the fee will be mailed to you. You will only receive an invoice if the tax identification number on your enrollment application does not identify you as a currently enrolled Medicaid provider.
What are the acceptable forms of payment?
Acceptable forms of payment are regular check, money order or certified check made payable to the N.C. Division of Medical Assistance.
PLEASE DO NOT SEND PAYMENT WITH YOUR ENROLLMENT APPLICATION. Once your enrollment application is received, CSC will mail an invoice for the enrollment fee to you. Please follow the detailed instructions provided on the invoice to remit payment.
What happens if I don't pay the enrollment fee?
Applications will be held for 30 days. If payment is not recevied 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.
Can I pay my provider enrollment fee online if I'm completing an online application?
No. CSC cannot process online payments at this time. CSC will mail an invoice to you with detailed instructions for how to remit your payment.
Will my Medicaid claims payments be impacted when CSC begins processing applications on April 20, 2009, or when CSC begins verifying information for currently enrolled Medicaid providers?
No. There will be no impact to claims submitted to HP Enterprise Services for processing and payment will not be impacted. HP Enterprise Services will continue to process all Medicaid claims until August 2011.
