Federal Fee and NC Application Fee FAQs

This list reflects answers to frequently asked questions regarding the federal fee and NC Application Fee.

  • 1. What is the federal fee?

    October 1, 2012, the N.C. Division of Health Beneftis (DHB) began collecting the federal fee required under Section 1866(j)(2)(C)(i)(l) of the Affordable Care Act (ACA) from certain Medicaid and N.C. Health Choice (NCHC) providers. The Centers for Medicare & Medicaid Services (CMS) set the fee, which may be adjusted annually.

    The federal fee is required for the following:

    1. Initial enrollment application
    2. Re-enrollment application
    3. MCR to add a new site location
    4. Re-verification application

    This fee only applies to certain organizations. Refer to the Provider Permission Matrix under Quick Links on the Provider Enrollment page to determine provider-specific enrollment requirements.
     

    Effective January 28, 2018, 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.

  • 2. Why am I required to pay the federal fee?

    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, including those under section 1866(j) and section 1128J of the Social Security Act.

  • 3. Which types of providers are required to pay the federal application fee?

    This fee only applies to certain organizations. It does not apply to individual physicians or non-physician practitioners. It also does not apply to providers who are enrolled in either “Health Insurance for the Aged and Disabled” or another state's Medicaid or Children’s Health Insurance Program plan.

     

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

  • 4. Do I need to pay both the NC Enrollment Fee and the federal fee?

    Yes. The North Carolina Medicaid application fee is $100.00 and covers the costs associated with processing the enrollment application. The federal fee covers the costs associated with screening. Both fees 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."

  • 5. How much is the federal fee?

    The federal fee 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.

  • 6. Why are providers required to pay the N.C. Medicaid and N.C. Health Choice Application fee?

    Session Law 2017-57 Senate Bill 257 Section 11H.3 Provider Application and Re-credentialing Fee mandated: (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.

  • 7. When is the $100 N.C. Medicaid and N.C. Health Choice Application fee required?

    1. Initial Enrollment (Note: If the application is abandoned, withdrawn, or denied, the provider will be required to pay the application fee again upon re-submission of the application.)
    2. Five-year Re-verification
    3. Out of State (OOS) providers who choose the full enrollment option by completing a MCR
    4. OPR Lite Enrollment
  • 8. What do I do if I have already paid the federal fee to another state, Medicare, or on an application that was withdrawn/denied?

    If a provider has paid the federal fee to another state, Medicare, or on a previous application that was withdrawn/denied, they can avoid doing so again when submitting a new/second application. Providers should indicate they have already paid the fee by 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 to another state or Medicare?” the provider should answer the question as applicable:

    1. Select ‘Other State’ or ‘Medicare’ (select other state if previous application denied)
    2. Select appropriate state if necessary (select ‘North Carolina’ from State drop down menu if previous NC application denied)
    3. Attach federal fee payment confirmation from the previous application, other state, or Medicare.
    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 with the reference number and on what date.