Document Category: Health Benefits/NC Medicaid
-
dma-1049 Cover Letter for LIS Application for Medicaid
-
dma-0100 Physician’s Signature for Authorization of Level of Care
-
dhb-8010sp Notice of Overpayment For Medical Assistance (Spanish Version)
-
DHB-8020-ia Medicaid Eligibility Corrections Form
-
dhb-7098-I DMA-7098 – Additional Information and Instructions Feb 23, 2021
-
dhb-8010 Notice of Overpayment For Medical Assistance
-
dhb-7097-ia Recipient Request and Authorization to Disclose Health Information
-
DHB-7078A Application 2nd Party Review Worksheet
-
DHB-7078R Recertification 2nd Party Review Worksheet
-
dhb-7061 Voluntary Wage Withholding Agreement