North Carolina Medicaid Enrollment and Billing

 

 

  

Medicaid Enrollment Requirements

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In Order to Meet Eligibility to Enroll with NC Medicaid as an Ordering, Prescribing, and Referring (OPR) Lite Provider You MUST...

☑ Be a Licensed Pharmacist Registered with the NC Board of Pharmacy
☑ Be a Confirmed Pharmacist Immunizer/Vaccinator in NC Board of Pharmacy Database
☑ Have your own unique National Provider Identifier (NPI) Number

To check vaccinator status with the NCBOP see Licensure Gateway | North Carolina Board of Pharmacy(ncbop.org)



Don't Have an NPI#?

  1. Visit https://nppes.cms.hhs.gov/#/
  2. Click CREATE or MANAGE an ACCOUNT:  Follow steps to create a User ID and Password.
  3. Check your email for ACKNOWLEDGEMENT OF REGISTRATION. Use the link provided in your email to access the CMS Identity & Access (IA) Management System website.
  4. Select CREATE ACCOUNT NOW in the CMS (IA) Management System Website to begin the NPI application process.
  5. IMPORTANT: When prompted:  Use the drop-down arrow associated with the Choose Taxonomy field and select 183500000X- Pharmacist. Insert License number and State Issued. Click SAVE.  
    NOTE: Your NPI# must be linked to this taxonomy to successfully enroll with Medicaid as a OPR Lite Provider
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Already Have an NPI#?

Follow the steps to update your existing account or add a taxonomy code:

  1. Visit the NPPES website and log in using your Identity & Access (I&A) User ID
  2. Scroll down to 'Manage Provider Information' and select the pencil icon to edit your existing NPI record.
  3. Using the gray menu bar located down the left column of the page or the numbered menu located across the top of the page, Click the NPI record you wish to update/modify.
    • Note: If you haven’t checked your NPI profile recently, review it to make sure all information is current. Medicaid will compare data from NPPES with the details you provide in your Medicaid enrollment application for accuracy.  Any inconsistencies may cause delays in Medicaid Provider Approval. For instance, if your NPI is under your maiden name and you use your married name in the Medicaid application, it will result in a denial and delay your application’s approval until the discrepancy is resolved.
  4. To add a taxonomy code, select taxonomy from the menu bar, use the drop-down arrow associated with the Choose Taxonomy field and select 183500000X- Pharmacist. Insert License number and State Issued. Click SAVE.