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Division of Medical Assistance
Providing access to high quality, medically necessary health care for eligible North Carolina residents through cost effective purchasing of health care services and products.
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Federally Qualified Health Center/Rural Health Clinic (FQHC/RHC) Cost Report

The cost report forms and instructions can be viewed/printed directly on-line using the Adobe Acrobat Reader (.pdf) version or downloaded to your computer. The free Adobe Acrobat Reader is required to view or print PDF publications. If you do not have Acrobat Reader, get it here!

Also, there is a Microsoft Excel (5.0 and later) version of the cost report forms available for download.

IMPORTANT NOTICE -- The cost report forms were changed for FY 2007 to accept the new National Provider Identifier (NPI) number per HIPAA regulations. You must enter both the old N.C. Medicaid provider numbers as well as the new NPI number to ensure proper matching for all claims processed by the Intermediary. If you do not have an NPI number at this time, be aware CMS is requiring all providers to be in compliance by May 23, 2008.

Visit the CMS website for more information at NPI Overview

2008 Freestanding FQHC/RHC Facility - Cost report due 150 days after facility FYE 

2008 Hospital-based RHC Facility - Cost report due 150 days after facility FYE 

2007 Freestanding FQHC/RHC Facility - Cost report due 150 days after facility FYE 

2007 Hospital-based RHC Facility - Cost report due 150 days after facility FYE 

 

If you have problems or questions about obtaining or using the software or forms, visit the Audit Section FAQ web page for helpful information.

Updated February 14, 2008