Approval to Practice (Approval to Practice application)
Prescriptive Authority (DEA#, CS Schedules, Permit to Dispense)
Reimbursement (Provider Numbers, Medicaid ‘Z’ Number)
All nurse practitioners must submit an application for what North Carolina regulations term Approval to Practice. An application for approval to practice may be obtained from the NC Board of Nursing (BON) (see below).
Once completed and returned to the BON, applications are reviewed by members of the Joint Subcommittee of the BON and the NC Medical Board. As well as approving NP applications, this six-member group (three from nursing and three from medicine) is responsible for promulgating new NP rules and regulations.
To find the next Joint Subcommittee meeting, contact the BON (see below). This information and directions may also be obtained from the NC Medical Board (see below).
The medical members of the Joint Subcommittee will review NP applications at the meetings of the NC Medical Board. NP applications are due into the BON office 45 days prior to these meeting dates.
North Carolina nurse practitioners have had prescriptive authority since NC statutes were amended to recognize NP practice in 1970. A formulary was used until 1994. At that time, the NP rules were amended to allow drugs and devices to be prescribed according to a drug and device agreement mutually agreed upon by an individual NP (or group of NPs in the same practice) and her/his primary supervising physician. This change was intended to allow NPs to customize what drugs and devices would be used in their particular practice setting.
NPs may also prescribe controlled drugs from Schedule II-III for up to a 30 day supply with no refills, and from Schedule IV and V with refills of up to one year (see link to Schedules below). Prescribing controlled drugs requires a DEA number that can be obtained from the regional office of the Drug Enforcement Agency located in Greensboro, NC (see below).
Dispensing drugs at your practice site requires a Permit to Dispense from the NC Board of Pharmacy (see below).
Drug Enforcement Agency
Phone: 336-547-4219 (Call for DEA number.)
Website is for general information only: www.deadiversion.usdoj.gov
NC Board of Pharmacy
North Carolina law has mandated the reimbursement of nurse practitioners, certified nurse midwives and psychiatric-mental health clinical nurse specialists by indemnity insurance plans since 1994. Managed care companies were not addressed in this legislation. In 2001, NC Session Law 1001-446, known as the Patients’ Managed Care Bill of Rights, provided for reimbursement to nurse practitioners, as advanced practice nurses, for services given within their scope of practice. In the case of managed care plans that require the use of network providers, the NP must be within the network to receive reimbursement. Upon written request of the supervising physician, NPs, as primary care providers, are eligible for inclusion in managed care network provider directories.
In spite of this law, NPs are still being denied access to network or out-of-network panels by managed care companies. If you have been denied the opportunity to apply for a managed care company panel, please let us know by sending an email to NCNA.
Medicare has directly reimbursed NPs since January 1998 as part of the Balanced Budget Act of 1997. NPs are reimbursed at 85% of physician fee schedule for a covered service.
To obtain a Medicare Provider Number, contact Cigna at the regional office in Tennessee (1-615-782-4509). Cigna is the Medicare carrier for North Carolina.
Medicaid directly reimburses North Carolina NPs at 100% of the physician fee schedule if they are self-employed.
To obtain a Medicaid Provider Number, contact the NC Medicaid Provider Enrollment Section at 919-855-4057.
To allow pharmacists to fill prescriptions for patients on Medicaid, a ‘Z’ number is needed. UPIN numbers are no longer used.
To obtain a ‘Z’ Number, call 919-855-4302. Contact person is Lisa Week.