How can my out of state SC Dr become a NC Medicaid Provider if they are located within the NC Tracks defined "Border Area"?

TLDR: SC medicaid provider Doctor keeps saying they cannot accept NC Medicaid even though they are within the border town area and are eligible to enroll as NC in state providers. Can this be done?

Ok so Im a NC resident and I get treatment in my neighboring state of SC bc I live a mile from the state line and this is my closest facility. I have BCBS of NC from the health exchange.

NC just expanded Medicaid and now I will fall below the limit of being able to pay for my own insurance. Now I will have to be on medicaid.

My provider is a MAT clinic. They have always said they can't take out of state Medicaid. I have went out of my way to buy my own insurance to be able to have coverage for this very necessary life savings treatment for me and my partner. Any wrench in this could cost us our life.

The MAT provider is also a SC medicaid provider.

But what I don't understand is if they fall within 40 miles of the NC border then they should be able to enroll to be a NC provider per the NC Tracks website for provider enrollment. https://www.nctracks.nc.gov/content/public/providers/provider-enrollment/getting-started.html

It states "Providers within 40 miles of the border of North Carolina are eligible to provide in-state Medicaid services for the State of North Carolina". The zip code for the SC town my provider is listed as eligible to be a NC provider.

I talked to the billing and office manager today and she said that billing has to be for the rules of whatever state you are in and it doesn't matter what NC says bc SC would be who determines stuff. And I just don't understand what she means by this.

I kept saying well can't you enroll as a NC provider and she didn't give me an answer I understood. It kept coming back to no bc SC would reject it or idk.

So I wondered if anyone here could give me clarity on what she meant by that. Or if they could answer how or if this could be done?!

submitted by /u/b_evil13
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