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Hearing Loss and Auditory Processing Forms

Hearing Aid Post Dispensing Evaluation Form

Note:  The following forms can be found on the NCTracks Prior Approval Web Page

  • Hearing Aid Services Request for Prior Approval (DMA-0001)
  • Auditory Implant Sound Processors Request (DMA-0003)

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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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