Provider Enrollment

The free Adobe Acrobat Reader is required to view and print these forms.

Please select your provider type from the menu below and click GO to access the provider enrollment application.

The N.C. Medicaid Program 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 Division of Medical Assistance's Provider Services unit completes this verification to ensure that all providers are in good standing in the community.

The entire process for enrollment takes approximately 6 to 8 weeks from the receipt of a complete and correct packet. Once participation as a Medicaid provider has been approved, providers are assigned a Medicaid Provider Number with an effective date and are notified by mail. Providers may begin submitting claims to Medicaid upon receipt of their Medicaid Provider Number.

Providers are not guaranteed a retroactive effective date and are strongly encouraged to provide services only after they are enrolled as a Medicaid provider. However, DMA will consider specific requests for retroactive effective dates if a recipient has been granted retroactive eligibility, an emergency service was provided, or medicallly necessary services were rendered and the provider's credentials, licensure, certifications, etc. were active and in good standing for the earliest requested date of service.

DMA Provider Services 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.

While the provider enrollment packets are designed to be completed by a provider with minimal assistance, if assistance is needed, please contact DMA Provider Services by mail at the address listed below or by fax (919-715-8548) or phone (919-855-4050).

Provider Enrollment Packets may be sent by U.S. Postal Service, please to:

DMA Provider Services
2501 Mail Services Center
Raleigh, NC 27699-2501

We accept overnight delivery from Fed Ex, DHL, and UPS.  We are unable to accept overnight delivery from the U.S. Postal Service. Please send overnight packages to:

DMA Provider Services
801 Ruggles Dr
Raleigh, NC 27603

Announcements

• Beginning February 1, 2008, all submitted provider enrollment packets must contain a signed Letter of Attestation.  Providers will be notified by email, telephone, or written correspondence if a Letter of Attestation or a new provider enrollment packet must be submitted.
• Suspension of New Enrollment for Community Support Providers

False Claims Act

• Letter of Attestation
• More False Claims Act Information
  

Quick Links

• Clinical Coverage Policies and Manuals
• Reporting a Change in Provider Status
• Zip codes within 40 miles of the NC border

Calendars

• Checkwrite Schedule
• Holiday Schedule
• Provider Seminars