Provider Enrollment: Welcome
The provider enrollment application allows an organization to enter all pertinent Medicaid enrollment information via a wizard. The enrollment wizard captures key provider data, such as contact information, provider type, specialties, and provider demographics, including names, identifiers, locations, and languages.
The provider enrollment wizard allows you to navigate through each page of the application, from the contact information on the first page, to the final print and cover sheet upon the submission of your application. Various features have been provided to help you enter your relevant information and to ensure that you provide the appropriate attachments to accompany your application. A tracking number is also provided so that you can check the status of your enrollment request.
Navigation
A table of contents appears at all times during the enrollment process to show your current location in the process.
As you navigate through each page of the enrollment wizard, all previous pages in the wizard are displayed in the table of contents as a link. You can click any link to navigate back to that page to apply changes, if needed. You cannot navigate forward past any page that has not yet been completed.
If you would like to finish your partially completed application at a later time, you can save your current progress by clicking Finish Later on any page after you have entered the required information on the Request Information page.
You can cancel the provider enrollment process at any time. When an application is canceled, all data that has been entered will be lost and you will be navigated out of the provider enrollment application.Getting Started