Alternative and Augmentative Communication Referrals

Medical billing for augmentative communication referrals at NCATP currently requires the forms below. Refer to the Medical Billing Directions for further information.This process is for persons that will use Medicaid (ages 0-21 only) or private insurance for payment.

Note: If funding other than private medical insurance or Medicaid is used, please refer to the �AT and Training Referral� page.

Medical Billing Directions**

Medical Billing Form**

AT Referral for Services**

Financial Policy Acknowledgment

Financial Policy Acknowledgment (Spanish)

**You can complete these forms on your computer and mail them with your packet to the address below.

Please mail the following information to:

Intake Coordinator | North Carolina Assistive Technology Program | 2801 Mail Service Center | 805 Ruggles Dr.  | Raleigh, NC  27699-2801

Or

919-855-3564 (Phone)
919-715-1776 (Confidential FAX)
[email protected]

Frequently Asked Questions

Return to Making a Referral