📋 Here is excerpt from NC Tracks article:
"Providers were notified on June 20, 2025, and July 3, 2025, in NC Tracks about the requirement to include the Ordering and Referring Provider (OPR)National Provider Identifier (NPI) on their billing claims.
This requirement is outlined in Federal Regulation 42 CFR 42 455.410, which requires the NPI of any ordering or referring physician or other professional to be specified on any claim for payment. To be reimbursed for services or supplies resulting from a practitioner's OPR, the OPR provider must be enrolled in NC Medicaid.
Community Alternatives Program (CAP) claims submitted for processing on and after June 15,2025, had to meet the requirements described above for the proper adjudication of those claims.
Effective July 3, 2025, claims submitted for the Community Alternatives Program for Children and Disabled Adults (CAP/C and CAP/DA) without the ordering or referring physician NPI will be adjudicated with a pay status. The implementation of pay and report allows providers extra time to update their electronic billing systems to comply with CFR 455.440. This is a federal mandate, and NC Medicaid must comply.
An assessment of provider readiness will be conducted in Oct. 2025. An announcement will be posted in advance of the period when NC Tracks will conclude the pay and report and switch back to a denial status resuming non-payment when the ordering and referring NPIs are not included in the claim.
For more information, please see the June 20, 2025, and July 3, 2025, NC Tracks announcements."
Click here for the NC Tracks article.
✅ Tip: How to Make Sure Your Doctor Information is Entered and Accurate:
Step 1: Go to Reports and select Download New Reports.
From Reports, go to Doctor > NC Medicaid CAP Patients and click Print the Report.
Step 2: If the doctor information is missing or needs to be updated, go to Codes > Other Basic Codes > Doctors.
To Add a Doctor:
a. Click the Add button from the top, left and select a code to use.
b. Fill in the doctor information and press Save. For quicker data entry, type in the NPI number then click the Validate using NPPES button. Then click on one of the import options below.
Click Save when finished.
c. Add the doctor to the patient's referral: Referrals > Dr. + Pharmacy tab. Type in the code you just created in the Primary (Ordering) Physician field. Save the referral.
To Edit a Doctor:
a. Type in the Doctor Code at Primary (Ordering) Physician field. If you do not know the code, type in the last name to generate a list of doctors with that last name.
b. Make your necessary changes; or click the Validate using NPPES button to verify your information is accurate. Click on the import option you prefer. Click Save when finished.
RECOMMENDED:
Utilize the "Check NC Tracks for Enrollment" option to verify physician is enrolled with NC Tracks. This is listed at the bottom of the "Add New Dr/Facility window." Go to Referrals > Dr. + Pharmacy tab, then proceed with these instructions:
a. Click the "Create a Doctor" tab > Type the doctor code in the "Search For" field.
b. At the bottom of the screen, you will see the following tab options. Click License Numbers. You will then have an option to check for enrollment.
c. Click Check NCTracks for Enrollment link.
d. A separate window will appear: NC Tracks Practitioner Search. The NPI will automatically pull from Barnestorm and appear on this screen. Click the FIND NOW button at bottom right of that window. If the doctor is enrolled, the information will populate. If the doctor shows as not enrolled, verify you have the correct NPI and try again.