EFFECTIVE FEBRUARY 1, 2013 THE ALLIANCE PROVIDER NETWORK IS CLOSED. Get more information.

Please note that MAY 15 IS THE FINAL DATE for providers who received a request for additional information to return all documentation necessary to complete credentialing. Providers, refer to the May 10 Weekly Update for additional important credentialing information!

Credentialing/Enrollment Resources

DOCUMENTS BEING REQUESTED IN APPLICATION SCREENING
Culture, Gender and Linguistics Data Form
Attestation Statement
Supplemental Information on Managing Employees, Owners, Directors and EFT Authorized Employees
Automobile Waiver Attestation Form
LP Roster
Background Release Form
Site Enrollment Form

FOR LICENSED PRACTITIONERS AND PROVISIONALLY LICENSED/ASSOCIATES
(The Network is closed for Licensed Independent Practitioners)
Step-by-Step Credentialing Instructions
Enrollment Application and Related Documents

FOR HOSPITALS
Step-by-Step Credentialing Instructions
Enrollment Application and Related Documents

HELPFUL CREDENTIALING RESOURCES
FAQs
NC Medicaid Special Bulletins on Waiver Expansion
February 2012
March 2012
April 2012

News LATEST: Op-Ed from CEO Ellen Holliman

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