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Provider Enrollment
Tuesday 12/03/2024 12:52 PM
Provider Enrollment
Provider Enrollment Application
Initiate a new provider enrollment application (includes optional Electronic Fund Transfer (EFT) enrollment).
Resume Enrollment
Resume an existing application for the following reasons:
Application has been saved but not yet been submitted
Application has been RTPd for correction
Application attachments need to be added
Enrollment Status
Check the current status of an enrollment application.
Customer Links
W-9 Form
Provider Enrollment Type and Specialty Matrix
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