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NC Department
of Health and
Human Services
Provider Enrollment
Provider Enrollment

Notice to Applicants

As of September 1, 2009, and in accordance with NC Session Law 2009-451, Section 10.58.A, the Division of Medical Assistance will charge an enrollment fee of one hundred dollars ($100.00) to each provider enrolling in the NC Medicaid program for the first time. CSC will contact enrolling providers by return mail with instructions on how to make payment of the non-refundable enrollment fee. See the September 2009 Medicaid Provider Bulletin and the Provider Fee FAQs for additional information.

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Enrollment Process

NC DHHS recognizes the need to promote access to care by enrolling all providers in a timely manner and is committed to ensuring the provision of quality care for our citizens.

The enrollment process includes credentialing, endorsement, and licensure verification. The CSC EVC Center completes this verification to ensure that all providers meet the professional requirements and are in good standing.

Once participation as a DHHS provider has been approved, providers are notified by mail and may begin submitting claims to NC DHHS for services rendered.

The CSC EVC Center cannot provide special consideration for processing of enrollment applications due to provider error, incomplete information, or due to a delay in obtaining credentialing, endorsement or licensure information from another agency.

Applicants must meet all program requirements and qualifications for which they are seeking enrollment before they can be enrolled as DHHS providers. Specific qualifications for each provider type are listed in the Provider Qualifications and Requirements Checklist (2,965 KB PDF).

Online Enrollment Applications

You can enroll in the NC DHHS programs online using the Online Enrollment Application. If you choose to use the online application, you will still have to mail in signature pages to complete the application. At the end of the online enrollment application, you will be given instructions for mailing in the necessary documents.

To assist you with completing an application, you will need the required information readily available. See the Provider Qualifications and Requirements Checklist (2,965 KB PDF). Once you have completed minimal required information, you will be given a Reference ID #. Use the Reference ID # to complete an in-process application.

There is help available on each screen to assist you with filling out the online application.

When you are completing an Individual or Organization Provider Enrollment application, you will be given the option to also enroll as a Primary Care Provider (PCP) in the DHHS Community Care of North Carolina/Carolina ACCESS (CCNC/CA) program if your provider type qualifies you to participate. CCNC/CA Eligible Provider Types.

Download PDF Applications

You can also download the Provider Enrollment Application in Adobe PDF format. The completed application and all applicable forms and attachments must be mailed to CSC.

If your provider type qualifies you to be a PCP, you can also enroll in CCNC/CA. CCNC/CA Eligible Provider Types.

Questions

If you have any questions regarding the completion of enrollment applications, you may contact CSC EVC Center by phone (866-844-1113), fax (866-844-1382), or e-mail (NCMedicaid@csc.com).

For More Information

For more information about billing, filing claims, and clinical coverage policies, see the DMA Provider website.