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NC DHB »
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Cost Reports and Assessments »
Rural Health Clinics/Federally Qualified Health Centers Cost Report - Freestanding

Rural Health Clinics/Federally Qualified Health Centers Cost Report - Freestanding

2019

Cost report due 150 days after facility FYE

  • Cost Report Instructions for FY2019 Freestanding RHC facility 
  • RHC Cost Report FY2019 - Excel Version 

2018

Cost report due 150 days after facility FYE 

  • Cost Report Instructions for FY2018 Freestanding FQHC facility
  • FQHC Cost Report FY2018 - Excel Version
  • FQHC Cost Report FY2018 - PDF Version
  • Cost Report Instructions for FY2018 Freestanding RHC facility 
  • RHC Cost Report FY2018 - Excel Version 
  • RHC Cost Report FY 2018 - PDF Version 

2017

Cost report due 150 days after facility FYE

  • Cost Report Instructions for FY2017 Freestanding FQHC/RHC facility
  • FQHC/RHC Cost Report FY2017 - Excel Version
  • FQHC/RHC Cost Report FY2017 - PDF

2016

Cost report due 150 days after facility FYE

  • Cost Report Instructions for FY2016 Freestanding FQHC/RHC facility
  • FQHC/RHC Cost Report FY2016 Excel Version
  • FQHC/RHC Cost Report FY2016 PDF Version

    Contact

    NC Medicaid Finance Section
    John Mathewson, CPA, Audit Manager
    Phone: 919-527-7161
    Fax: 919-527-0600

    Cost Reports and Assessments

    • Ambulance (EMS) Cost Report
    • Hospital Cost Report
    • Intermediate Care Facility - Individuals with Intellectual Disabilities (ICF-IID) Cost Report
    • Intermediate Care Facility - Individuals with Intellectual Disabilities (ICF-IID) Cost Assessment
    • Local Education Agencies (School-based Services) Cost Report
    • Nursing Facility Cost Assessment
    • Nursing Facility Cost Report – Long-term Skilled Nursing Care
    • Nursing Facility Cost Report Long-term Skilled or Intermediate Nursing Care Home Office
    • Nursing Facility Cost Report – Long-term Skilled or Intermediate Nursing Care Hospital Based
    • Nursing Facility Fair Rental Value (FRV)
    • Rural Health Clinics Cost Report - Hospital-based
    • Rural Health Clinics/Federally Qualified Health Centers Cost Report
    • Federally Qualified Health Centers
    • Intermediate Care Facility - Individuals with Intellectual Disabilities (ICF/IID) Cost Report - Home Office or Related Party Support
    • Local Health Department
    • Nursing Facility Cost Reports

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    Contact Information

    NC Medicaid
    Division of Health Benefits
    2501 Mail Service Center
    Raleigh, NC 27699-2501
     
    NC Medicaid Contact Center
    Phone: 888-245-0179
    Monday-Friday 8 a.m. to 5 p.m.
    Closed on State holidays. 
     
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