Manuals, Forms, and Guides

Provider Manuals

• Provider Manual (PDF)
• Provider Billing Manual (PDF)

Provider Forms

• Provider Claim Complaint/Appeal Form (PDF)
• Prior Authorization Form (PDF)
  • For tip sheets and additional guidance, visit our Prior Authorization Page
• Personal Care Services Request Form (PDF) 
  • For more information, visit our PCS Page
• Primary Care Provider (PCP) Change Fax Form (PDF)
• Notice of Pregnancy Form (PDF)
• Massage Therapy Acknowledgement Form (PDF)
  • Massage Therapy Assessment Checklist (PDF)

Provider Guides

Getting Started

• Quick Reference Guide (QRG) (PDF)
• Secure Provider Portal Guide (PDF)
• Provider Portal Account Manager Guide (PDF)
• Prior Authorization Guide (PDF)

• Claims Submission Reminder Guide (PDF)
• 835 EDI Companion Guide (PDF)
• 837 EDI Companion Guide (PDF)
• 2022 AMA Coding Guidelines for Social Determinants of Health (PDF)

Reference Guides

• Accessing Your Payment Reports for Medical Home and Care Management PMPM (PDF)
• Converting your .TXT report files (PDF)
• Request to Move to NC Medicaid Direct or Local Management Entity-Managed Care Organization (LME-MCO) (PDF)
• Provider Tip Sheet for Pregnant Members (PDF)