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Submit forms online using Adobe Sign

You can submit some forms online using Adobe Sign. To submit a form online:

  1. Select the form you want to submit.
  2. Select “Go.”
  3. Use Adobe Sign to complete, sign and submit the form.

Adobe Sign is the fastest and best way to submit a form. It makes sure your form is complete and correct. It gives you tips while you fill out the form and tells you if something is missing or wrong.

Health Plan Change Request

  • Member:  Fill out and submit the Health Plan Change Request form.

Request to move to NC Medicaid Direct or Local Management Entity-Managed Care Organization (LME-MCO)

If a member is in a health plan and needs services they can only get in NC Medicaid Direct or the LME-MCOs for a serious mental health disorder, severe substance use disorder, intellectual and developmental disability (I/DD) or traumatic brain injury (TBI), use one of these forms:

  • Member: Fill out and submit the Request to Move to NC Medicaid Direct (Fee for Service) or LME-MCO: Beneficiary Form.
  • Provider: Fill out and submit the Request to Move to NC Medicaid Direct (Fee for Service) or LME-MCO: Provider Form.
    • For service associated requests, include a Service Authorization Request (SAR) and supporting documents.