Medium
Both individuals providing services and agencies employing individuals must complete provider enrollment process. The process includes these steps:
Medium
Step 1: National Provider Identifier (NPI) number
Obtain a National Provider Identifier (NPI) number. Determine if you will need an Individual NPI, Organization NPI or both.
Step 2: Complete the online application
Step 3: Provider Enrollment Checklist
- Obtain required forms by clicking on the links in the checklist
- Complete the required forms
- Sign any forms requiring a signature
- Gather required documents from your files (such as licenses, federal tax letters, bank letters, etc.) – These vary depending on the type of service/services you will be providing
- Submit all documents and forms with your checklist as a coversheet to Provider Enrollment
- Individual 1915(i) Provider Screening Policy
Step 4: Complete MCO Registration Process
Complete registration steps for provider access, billing, and EFT payment on MCO webpage.
Provider Affiliation and Termination Information
Enrolled Medicaid 1915(i) Providers affiliate/ terminate affiliated individuals.