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Welcome to Outreach of North Carolina!

Call Today!  877-901-5827

Outreach Health Services of North Carolina (Outreach) provides Financial Management Services to all qualified CAP/DA or CAP/C participants.

Senior Woman in WheelchairYour Self-Directed Care Partner

Outreach supports participants to successfully manage their care:

  • Conducting in-person enrollment meetings
  • Assisting with the completion of employer and employee forms
  • Providing easy to complete New Employee Packets
  • Accessing online systems for budget information, time entry, and reports
  • Brokering workers compensation for employees
  • Providing Employer Training Tools
  • Distributing an Employee Training Booklet
  • Processing payroll for employees
  • Assisting with employer related tasks
  • Monthly communication with the participant’s Care Advisor

About Outreach of North Carolina

Outreach Health Services Logo
Outreach of North Carolina is a subsidiary of Outreach Health Services, providing nationwide self directed care and home care services for over 40 years. We support 8000 participants, process payroll for 7000 employees and are developing services in new states. Our main goal is to provide outstanding customer service. We believe it is our responsibility to provide the participant with the right support and training tools to manage his or her care successfully.

To learn more about Outreach Health Services visit www.OutreachHealth.com

Participant Employer

Forms and Instructions

The following forms need to be completed by the participant so they can be set up as an employer through Outreach Health Services. This is needed for Outreach to provide payroll services to their employees.

Please take the time to download, review and complete the Participant Employer Packet and return the completed forms to Outreach Health Services. You can fax the completed packet to 866-463-7589.

Participant Employer Packet
Participant Employer Packet contains forms to be completed by the a new participant employer.
Participant Information Form
The Participant Information Form is used to set up the new participant in the Outreach system.
Form 2678 Employer/Payer Appointment of Agent Form
This form is needed for Outreach to be able to process your employee federal taxes withholdings based on the W4 filled out by an employee.
Financial Management Agency Transfer Form
This form is needed for Outreach to be able to pay your medical bills using medicare. It provides Authorization for Outreach to be your Fiscal Intermediary.
Pre-Authorization Form
This form is used to provide Outreach with the information needed to calculate a preliminary budget for participants selecting CAP/Choice.
Gen-58 Power of Attorney
This form gives Outreach permission to be your agent in NC and file taxes on your behalf.
Employee Wage Change
The Wage Change form is used to notify Outreach Health Services of a change in wage for an employee.
Attendant Termination Notice
This form is used to notify Outreach Health Services when an employee is terminated. This form must be sent to Outreach within 24 hours of terminating an employee. The completed form can be faxed to 1-866-463-7589 or E-mail to Outreach.HealthNC@outreachhealth
FLSA Employee Overtime EXEMPTION
This form is used to exempt you from paying your employee overtime. Use the Department of Labor self-assessment to determine if you are required to pay your employee overtime pay. Please fax this form to 866-463-7589.
Personal Representative
This form is used to designate a personal representative to assist/support in overseeing of your care.

Participant Employees

The following forms are used to enroll as a employee. Please take the time to download, review and complete the Employee Packet and return the completed forms to Outreach Health Services. You can fax the Employee Packet using our toll free fax, below.

Toll Free Fax: 866-463-7589

It is very important that you complete these forms and return them to Outreach as quickly as possible.  You will not be paid for work time until these forms have been received and are processed by Outreach Health Services.

 

Money Network Mobile App - Video

Outreach provides the option to get paid using the Money Network Payroll Debit Card.

Watch this short video to learn how you can manage your money using the Money Network mobile application.

Employee Packet
The Employee Packet contains instructions, form explanation and forms to be completed by the a new employee.
W4 Form
The W4 form is for federal tax purposes and taxes are deducted from your pay based on the claim in this form. If claiming any exemptions from W4 please fill out the WT-4 form available on Outreach website. This form is included in the Employee Packet above.
1-9 Form
This form documents that you are eligible to work in the United States. This form is included in the Employee Packet above.
NC-4 Form and Worksheet
The NC-4 is for state tax purposes and taxes are taken from your pay based on claim in this form. The NC-4 form is included in the Employee Packet above.
Money Network Application and Deposit Agreement
The Money Network Payroll Debit Card (“Card”) provides a dependable, safe, optional, and convenient way for you to receive and access payment for your services. Outreach strongly encourages use of direct deposit or pay card. This form is included in the PWH Packet above.
Debit Card Terms and Conditions
This document outlines the terms and conditions governing the use of the debit card for your pay deposit. If you choose to use the debit card to receive your pay, please take the time to read this document.
Direct Deposit Authorization Form
This Direct Deposit Authorization form is used to authorize direct deposit for payment of services. Outreach strongly encourages the use of direct deposit or debit card for to receive your pay.
Direct Deposit Cancelation Form
The Direct Deposit Cancelation form is used to cancel direct deposit for payment of services.
Employee CAP/C Task List
This Employee CAP/C Task List is a Microsoft Word document that can be used to create a task list for an individual service plan (ISP). The employee uses this list to track their tasks performed each week.
W-2 Request Form
This form is used to request a copy of your W-2 form.

Payment Forms

Forms and Instructions

The following forms are used by the participant's employee to receive payment.  Timesheets must be submitted, by fax or Outreach Member Portal, before midnight on the timesheets due date listed on the Payroll Calendar.

Toll Free Fax: 866-463-7589
Outreach Member Portal: www.outreachhealth.com/NC

2019 Payroll Calendar
Shows when timesheets are due and paycheck are issued for the 2019 calendar year.
Weekly Task Sheet
The Weekly Task Sheet form is used to document the services provided by an employee for a participant.
Time Sheet - Adult
Used to submit your hours to Outreach Health Services for payment. Note: Only use this form for the appropriate program or services. Contact your Service Representative for more information.
Time Sheet - Children
Used to submit your hours to Outreach Health Services for payment. Note: Only use this form for the appropriate program or services. Contact your Service Representative for more information.