State Guide

Credentialing in North Carolina

Enrollment guides for 52 payers operating in North Carolina.

What actually differs in North Carolina

Credentialing advice written for "most states" tends to be wrong here in specific, expensive ways. These are the rules that only apply in North Carolina.

4 sourced rules, each linked to its source

Getting enrolled 2 Rules that decide your timeline 1 Who on your team can bill 1

4 sourced rules

Every claim on this page links to the statute, rule or agency page it came from. Last checked July 2026.

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NCTracks, single credentialing front door

All North Carolina Medicaid providers, including behavioral health, enroll and are credentialed through NCTracks; since the move to managed care, the LME/MCOs no longer perform credentialing. One state front door, then contract with each health plan's network. Reverification runs on a 5-year cycle with ~70 days to complete after notice, then suspension on the due date and termination 50 days into suspension, so calendar it at 60 days out.

NCTracks BH Provider Enrollment FAQs via kb/states/nc.md · checked Jul 2026

Standard Plans vs Tailored Plans (acuity split)

North Carolina splits behavioral health by acuity: Standard Plans cover mild-to-moderate BH for the general managed-care population, while Behavioral Health & I/DD Tailored Plans, for serious mental illness, severe SUD, I/DD and TBI, launched July 1, 2024 under four LME/MCOs (Alliance Health, Partners Health Management, Trillium Health Resources, Vaya Total Care), each covering assigned counties. A provider credentialed only with Standard Plans cannot bill for members whose care sits in a Tailored Plan, map counties to plans before quoting go-live.

NC Medicaid Tailored Plans via kb/states/nc.md · checked Jul 2026

30-day prompt pay

North Carolina managed-care plans must pay or deny clean claims within 30 days.

NC Medicaid Provider Playbook Prompt Payment fact sheet via kb/states/nc.md · checked Jul 2026

Associates direct-enroll and bill their OWN NPI (cleanest in class) NC Medicaid CCP 8C §6.1 (amended 2025-01-01)

North Carolina is the cleanest associate-renders state we track: under Clinical Coverage Policy 8C, associates (LCSWA, LCMHCA, LMFTA, LCASA, plus LPAs) direct-enroll with Medicaid, hold their own MPN and NPI, and bill under them. Incident-to billing was explicitly discontinued (~2017-18). Two associate rails: a written service order from a physician, doctoral psychologist, NP or PA is required before or on the first treatment date (excluding initial assessment), and practice runs under the board's clinical supervision agreement. Associates still need Standard/Tailored Plan contracts after NCTracks enrollment.

NC Medicaid Clinical Coverage Policy 8C via kb/states/nc.md · checked Jul 2026

Want North Carolina handled for you?

A credentialing manager files the applications, chases the payers and tracks your recredentialing dates.

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Who Runs North Carolina Medicaid Provider Enrollment

50-state research

Enrollment Portal

NCTracks

Operated By

GDIT (formerly CSRA)

Platform

NCTracks

North Carolina is the only state on GDIT's NCTracks platform, so its screens and terminology are unique to the state.

From PayerReady's 50-state Medicaid enrollment platform research, verified July 2026. Portal contracts change; where an operator is in transition or not publicly confirmed, we say so rather than guess.

Aetna

Aetna (CVS Health)

Credentialing in North Carolina

What actually differs in North Carolina

Who Runs North Carolina Medicaid Provider Enrollment

Aetna

UnitedHealthcare

Cigna Healthcare

Anthem / Elevance Health

Humana

Centene Corporation

Molina Healthcare

Blue Cross and Blue Shield of North Carolina

NC Medicaid

UnitedHealthcare Community Plan

Amerigroup (Anthem)

WellCare (Centene)

AmeriHealth Caritas

TRICARE

TRICARE East Region (Humana Military)

CHAMPVA

Delta Dental

Cigna Dental

MetLife Dental

Guardian Dental

Aetna Dental

United Concordia

DentaQuest

MCNA Dental

Liberty Dental Plan

Dental Network of America

VSP Vision Care

EyeMed Vision Care

Davis Vision

Spectera / UHC Vision

Optum Behavioral Health

Carelon Behavioral Health

Magellan Health

Evernorth Behavioral Health

Alignment Healthcare

Workers' Compensation

Palmetto GBA (Jurisdiction J/M)

CGS Administrators (DME B/C)

Ambetter

AmeriHealth Caritas

Anthem Blue Shield

Blue Cross Blue Shield

Carelon

Centene Corporation

Community Plan

Compsych

Medicaid

Medicare

Medicare Fee-for-Service (CMS)

Megellan

MultiPlan

WellCare

Credentialing vs Enrollment

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