Forms
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- Agreement for Participation as a Primary Care Provider in North Carolina's Patient Access and Coordinated Care Program (Carolina Access) (103 KB PDF)
- Electronic Claims Submission (ECS) Agreement for Individuals (33 KB PDF)
- Electronic Claims Submission (ECS) Agreement for Organizations (Groups) (79 KB PDF)
- Medicaid Letter of Attestation (54 KB PDF)
- Pharmacy Online request for NC Medicaid claims Point-of-Sale (12 KB PDF)
- Provider Administrative Participation Agreement (105 KB PDF)
- Provider Certification for Signature on File (45 KB PDF)
- Reporting a Change in Provider Status
- W-9: Request for Taxpayer Identification Number and Certification (268 KB PDF)
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