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Endorsement Forms & Documents
If you need assistance:
Please contact a Provider Specialist in the Provider & Consumer Relations Department at 828-225-2785 or 1-800-671-6560 or contact the appropriate Provider Specialist listed on our Provider and Consumer Relations Page.
Available online documents:
Open them directly by clicking on them, or save them to disk (the easiest way on a PC is by right-clicking your mouse.) The files are in Word 2000, Excel 2000 and Adobe Acrobat 5.0 PDF files. Each document link is set to open in a new window.
| Communications | ||
| Bulletin #61 - 04/24/07 DMA Lapse Dates for Enhanced Benefit Services |
Word File | |
| Bulletin #59 - 04/13/07 Full Endorsement |
Word File | |
| Enhanced Services | ||
| Endorsed Residential Treatment Providers (04/27/07) | Excel (1.2M) | |
| Endorsement | ||
| Service Definitions (revised 03-27-06) | ||
| Western Highlands Provider Endorsement Instructions (12/13/07) | Word | |
For the most current endorsement information and documents please visit the Endorsement Section of the Division of Mental Health, Developmental disabilities and Substance Abuse Services website:
http://www.ncdhhs.gov/mhddsas/stateplanimplementation/providerendorse/index.htm
Division of Medical Assistance (DMA) Enrollment Applications can be downloaded from the DMA website at http://www.dhhs.state.nc.us/dma/provenroll.htm. Please note: This is the same application that is required to initiate the endorsement process with Western Highlands Network.