NC Medicaid School Based Services
PSU Provider Enrollment Preparation Fact Sheet
In 2023, the Centers for Medicare & Medicaid (CMS) released guidance that requires individual
practitioner enrollment to submit billing claims to Medicaid. By July 1, 2026, all eligible school-based
practitioners must enroll in North Carolina Medicaid.
NC Medicaid and NC Department of Public Instruction (DPI) have partnered to provide guidance to
assist public school units (PSUs) with this process. This prerequisite document and checklist are
intended to be used as a suggestion to help PSUs determine which practitioners will need to enroll.
PSU Provider Enrollment Preparation Fact Sheet
For general School-Based Services and Medicaid program inquiries or assistance, NC Medicaid offers a Provider Ombudsman to represent the interests of the provider community. NC Medicaid and NC DPI often coordinate responses. Inquiries may be followed to resolution through the NC Medicaid Help Center system. When contacting NC Medicaid, *please identify as a Public School Unit (PSU) or Local Education Agency (LEA) provider type, and have the following information ready:
• The name of your PSU/LEA and NPI number
• Your name and contact information (email and phone number)
• The general category of your inquiry (e.g., provider enrollment, clinical policy or claims) and explanation
• The urgency of your inquiry
The Provider Ombudsman and School-Based Services Team monitors the following email for school provider-related inquiries: Medicaid.SchoolBasedServices@dhhs.nc.gov. The Provider Ombudsman line is 866-304-7062.
Federal Resource Links:
CMS Guide to School-Based Services
School-based Medicaid TA Center
2019 HIPAA FERPA Joint Guidance
IDEA/FERPA Consent 1 pager
DHB Resource Links:
10C Policy
LEA Fee Schedule
Cost Report Instructions
Cost Report Template
This site is in the process of adding additional materials and resources.