Division of Medical Assistance Standardized Enrollment Application for Agencies for participation in the Medicaid 1915(b)(c) waiver network for Mecklenburg County.


The documents below are for the Agency Application Process for participation in the 1915(b)(c) waivers through MeckLINK Behavioral Healthcare. The documents include the DMA Standardized Enrollment Application for Agencies, narrative instructions and a process map for the application process, an application review check sheet, a policy and procedure review check sheet, and a self-study review sheet. It is MeckLINK Behavioral Healthcare’s desire for providers to successfully complete the application process and become a contracted partner in the provider network. To be successful in the application process, providers must read and adhere to the instructions for the application. Provider Applications received prior to 12:00 PM, October 1, 2012 will be part of the Standard Review process. Provider Applications received after 12:00 PM, October 1, 2012  will be processed in the order they are received. MeckLINK Behavioral Healthcare expects a large volume of provider applications and cannot guarantee applications received after October 1, 2012 will be processed prior to January 1, 2013.

Please note that the DMA Standardized Enrollment Application for Agencies is geared specifically to CABHAs, Specialty Service Providers, ICF-MR Providers, Innovations Providers (formerly CAP-MR), Other Enhanced Benefit Providers, and Incorporated Providers delivering services other than or in addition to Outpatient Behavioral Health Services. This is not the application for Licensed Independent Practitioners (LIPs) or Group/Outpatient Practices will complete to join the network. MeckLINK Behavioral Healthcare is currently finalizing the LIP application and process and will release it in the very near future. When the LIP application is released it will also include narrative instructions and a process map for LIPs and/or Group/Outpatient Practices to follow.

In keeping with the N.C. Medicaid Special Bulletin, eligibility for providers/practitioners to join the network is based on having submitted claims for Medicaid services provided to consumers with Medicaid originating from Mecklenburg County during the 60 days prior to submitting an application. If a provider is actively serving consumers with Medicaid originating from Mecklenburg County and has not submitted claims for those consumers during the 60 days prior to submitting their application, the provider must show evidence of actively serving those consumers. Additionally, providers should not view this as an opportunity to expand their service array. MeckLINK Behavioral Healthcare will only approve and contract for the services a provider has submitted claims for during the sixty (60) days prior to application or is actively providing to consumers with Medicaid originating from Mecklenburg County.

Application Process


MeckLink Agency Application Process
Questions & Answers About the Agency Application Process
Process Map Submitting Agency Application
For Provider Use P and P Review Form and Guide


Application Documents

Agency Checklist for Enrollment Application
MeckLINK Agency Enrollment Application
Agency Attestation
Core Rules Self Study

For questions regarding the Agency Application Process please contact Chuck Hill.