Enrollment is required at both the Group and Individual levels. Group Enrollment must be approved prior to Individual providers enrolling and affiliating under the group. The process for both Group and Individual enrollment includes the following steps:

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.

MCO Information

Provider Affiliation and Termination Information

Enrolled Medicaid 1915(i) Providers affiliate/ terminate affiliated individuals.