Terms and Conditions

The following links outline the terms and conditions set forth by the North Carolina Department of Health and Human Services.


Updated Aug. 1, 2025

DHHS Providers

NC DHHS Provider Administrative Participation Agreement

NC DHHS Provider Administrative Participation Agreement

All DHHS providers will electronically sign the Provider Administrative Participation Agreement as part of the Provider Enrollment Online Application. read on NC DHHS Provider Administrative Participation Agreement

NC DHHS Consent to Release Information

NC DHHS Consent to Release Information

All DHHS providers will electronically sign the Consent to Release Information as part of the Provider Enrollment Online Application. read on NC DHHS Consent to Release Information

Electronic Funds Transfer (EFT) Attestation

Electronic Funds Transfer (EFT) Attestation

All DHHS providers will electronically sign the EFT Attestation as part of the Provider Enrollment Online Application. read on Electronic Funds Transfer (EFT) Attestation

W-9 Attestation for Individuals

W-9 Attestation for Individuals

All DHHS providers will electronically sign the W-9 Attestation as part of the Provider Enrollment Online Application. read on W-9 Attestation for Individuals

W-9 Attestation for Organizations

W-9 Attestation for Organizations

All DHHS providers will electronically sign the W-9 Attestation as part of the Provider Enrollment Online Application. read on W-9 Attestation for Organizations

Medicaid Providers

False Claims Act Attestation

False Claims Act Attestation

All Medicaid providers will electronically sign the False Claims Act Attestation as part of the Provider Enrollment Online Application. Updated Aug. 1, 2025 read on False Claims Act Attestation

Community Care of North Carolina/Carolina ACCESS (CCNC/CA) Providers

NC DHHS Agreement for Participation as a CCNC/CA Provider

NC DHHS Agreement for Participation as a CCNC/CA Provider

All CCNC/CA providers will electronically sign the NC DHHS Agreement for Participation as a CCNC/CA Provider as part of the Provider Enrollment Online Application. Updated Aug. 21, 2025 read on NC DHHS Agreement for Participation as a CCNC/CA Provider

CCNC/CA providers who cannot, or choose not to, perform the comprehensive health check screenings must complete the NC DHHS Health Check Agreement between Primary Care Provider (PCP) and the Local Health Department.

 

Ordering, Prescribing, and Referring (OPR) Providers

NC DHHS OPR Provider Participation Agreement

NC DHHS OPR Provider Participation Agreement

Ordering, prescribing, and referring (OPR) providers will electronically sign the NC DHHS OPR Provider Participation Agreement as part of the Provider Enrollment Online Application. read on NC DHHS OPR Provider Participation Agreement

Out of State Lite Providers

NC DHHS Out of State Lite Provider Participation Agreement

NC DHHS Out of State Lite Provider Participation Agreement

Out of state (OOS) "lite" providers will electronically sign the NC DHHS Out of State Provider Participation Agreement as part of the Provider Enrollment Online Application. Full OOS providers will sign the regular NC DHHS Provider Administrative Participation Agreement. read on NC DHHS Out of State Lite Provider Participation Agreement

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