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NC Department of Health and Human Services
NC Division of
Medical Assistance

Program Integrity Letters and Forms

Self Audit:

Self-Audit Overview for Providers

Voluntary Self-Audit Forms

Provider Attestation

(The following form is editable and can be filled in electronically)

Provider Attestation Form: Catastrophic Event







Contact Information:
Phone: 919-814-0000
Fax:  919-814-0034 Ready NC Connect NC