Federal Fee and NC Application Fee FAQs

The N.C. Division of Health Benefits (DHB) collects the Federal fee as required under Section 1866(j)(2)(C)(i)(l) of the Affordable Care Act (ACA) from certain Medicaid providers. The Centers for Medicare & Medicaid Services (CMS) set the fee, which may be adjusted annually.

 

When required, the Federal Fee is collected for the following:

1. Initial enrollment application
2. Re-enrollment application
3. Adding a new owner or a new site location; and
4. Re-verification application

Refer to the Provider Permission Matrix under Quick Links on the Provider Enrollment page to determine provider-specific enrollment requirements.

 

The federal fee collection is automated; both the federal and NC application fee payments are collected upon application submission. NCTracks will not begin processing the application until the applicable fee(s) are paid.

Section 6401(a) of the Affordable Care Act (ACA) requires the Secretary to impose a fee on each "institutional provider of medical or other items or services and suppliers." The fee is to be used by the Secretary to cover the cost of program integrity efforts including the cost of screening associated with provider enrollment processes under section 1866(j) and section 1128(j) of the Social Security Act. For more information, please visit the notice titled Medicare, Medicaid, and Children's Health Insurance Programs; Provider Enrollment Application Fee Amount for Calendar Year 2025.

Refer to the Provider Permission Matrix under Quick Links on the Provider Enrollment page to determine provider-specific enrollment requirements.

NC General Statute 108C-2.1(a) mandates: (a) Each provider that submits an application to enroll in the Medicaid program shall submit an application fee.  The application fee shall be the sum of the amount federally required and one hundred dollars ($100.00).  (b) The fee required under subsection (a) of this section shall be charged to all providers at re-credentialing every five years.

Possibly. The North Carolina Medicaid application fee applicable to all enrollment and reverification applications covers the costs associated with processing the enrollment application. The Federal Fee is required as indicated on the Provider Permission Matrix and covers the costs associated with screening. Both fee amounts can be found under Quick Links on the Provider Enrollment home page by clicking on the link titled "Federal Fees & NC Enrollment Fees by Year".

The federal fee amount can be found under Quick Links on the Provider Enrollment home page by clicking on the link titled "Federal Fees & NC Enrollment Fees by Year." The Centers for Medicare & Medicaid Services (CMS) sets the application fee, which may be adjusted annually. The fee is used to cover the cost of screening and other program integrity efforts.

Providers submitting enrollment or revalidation/reverification applications will be assessed the $100 NC Medicaid Provider Application Fee. This is in addition to the Federal Fee imposed for specified taxonomies.

 

If a provider has paid the Federal Fee on a previous application and/or completed a federal site visit but that application was denied, they can avoid doing so again when submitting a new/second application. Providers should indicate they have already paid the fee and/or completed the site visit following the process of providing adequate proof outlined below.

 

When the provider comes to the page in the application with the questions “Have you paid the Federal Fee for this site within the past 12 months to another state or Medicare?” and “Have you completed the Federal site visit for this site within the past 12 months to another state or Medicare?” the provider should answer each question as follows as applicable:

 

1. If the fee has been paid or site visit conducted with a state, select ‘North Carolina’ or other state from the drop-down menu. Then choose the state which processed the site visit or federal fee.
2. If the fee has been paid or site visit conducted by Medicare, select ‘Medicare’ from the drop-down menu. Please note, NCTracks will confirm site visit and payment with Medicare based on the location matching the provider’s NC Medicaid application.    
3. Attach federal fee payment or site visit confirmation from the previous application
4. Attach documentation from PCG of completed and passed site visit and/or a letter identifying the enrollment application the site visit was passed for and on what date.

Note: If the Federal fee or Site Visit cannot be confirmed as indicated, the application may be withdrawn, or will be denied, and a new application submitted with the correct information.