This is the url
for LMFTs to apply to enroll as a medicaid provider:
http://www.dhhs.state.nc.us/dma/Forms/provenroll/marriagefamilytherapist.htm
Licensed Marriage and Family Therapist
To enroll as a Medicaid provider, please mail the following information
to:
DMA Provider Services
Attn.: Alison Stephenson
2501 Mail Service Center
Raleigh, NC 27699-2501
Completed and Signed
Mental
Health Services Application.
Must have Original Signature
Completed and signed
Medicaid
Participation Agreement form.
Must have Original Signature
DO NOT enter the
effective date
Copy of Completed
and Signed W-9 Tax
form.
Copy of Current
License to practice from the NC Marriage and Family Therapy Licensure
Board
Proof of Graduation
with a Masters Degree in Marriage and Family Therapy or an Allied Mental
Health Field
Providers are assigned
a provider number and are notified by mail once the enrollment process
has been completed. Providers can begin submitting claims to Medicaid
upon receipt of their Medicaid provider number. Billing information
and medical coverage policies are available on DMA's website at http://www.dhhs.state.nc.us/dma/prov.htm.
Providers are requested
to include on their application the name, e-mail address, and fax number
of the individual at their site that is responsible for receiving Medicaid
information. If you have questions about the enrollment process or documentation
requirements, Please contact DMA Provider Services, Alison Stephenson
Mental Health Enrollment Specialist at 919-855-4062.
