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Friday 09/17/2021 12:22 PM
Provider Enrollment Application
Initiate a new provider enrollment application (includes optional Electronic Fund Transfer (EFT) 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
Check the current status of an enrollment application.
Provider Enrollment Type and Specialty Matrix
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