New Customer

Please fill out the following information.

Please choose the services you provide:

CAP/PCS

Home Health

Hospice

Mental Health

Agency Name (exactly as registered with DHHS):

NPI

Tax ID

Main Office address

City

State

Zip

Owner First Name

Owner Last Name

Phone Number

How many aides will use EVV?

How many (non-visiting) office staff at your agency?

Are you enrolled in NC Tracks?

Are you enrolled in HHAeXchange for Medicaid MCOs?

Are you currently using Electronic Visit Verification (EVV)?

If you have not received a response within one business day, please contact us immediately by emailing customersupport@barnestorm.com.