Provider Services

Date: August 30,2009

Attention: All Providers

Web-based Provider Enrollment Applications Available Online Beginning August 31, 2009

CSC is pleased to announce that on August 31, 2009, providers will have the option to enroll online in the Medicaid and Community Care of North Carolina/Carolina ACCESS (CCNC/CA) programs. Providers may use the online applications to enroll, re-enroll, report a change of ownership, report a change of group name/tax name, report a change in tax number or to add services.

We are optimistic that the interactive web application will reduce the number of incomplete applications currently being received by the State. In addition, the following enhancements have been added to the current applications:

• When completing an Individual or Organization Provider Enrollment Application, applicants can simultaneously enroll as a Primary Care Provider (PCP) in the DHHS Community Care of North Carolina/Carolina ACCESS (CCNC/CA) program if the applicant’s provider type qualifies the provider to participate.

• A help feature is available on each screen to assist applicants with completing the online application.

• Once an applicant has completed minimal required information, a Reference ID number will be generated. The applicant must retain this Reference ID number to retrieve and complete a saved application. Applications must be retrieved within 90 calendar days.

At the end of the online enrollment application process, the applicant will have the option to print a copy of the submitted application for future reference.

Applicants who use the online application must submit supporting hard-copy documentation to CSC. The applicant will be given instructions for mailing the supporting documentation. Until the supporting documentation (with original signatures) is received, the application is not considered complete.

We encourage applicants to use the online application process. However, applicants who choose not to enroll online will have the option to download an application in Adobe Acrobat PDF format and mail the completed application and supporting documentation to CSC. Please note that any application received after October 1, 2009, must be submitted using the new web-based application or the downloaded Adobe Acrobat version of the new application. Previous versions of the Provider Enrollment Packets will not be accepted after October 1, 2009.

Applicants with questions regarding the completion of the online application should contact the CSC EVC Center by phone (866-844-1113), fax (866-844-1382), or email (NCMedicaid@csc.com).