1915(i) Provider Enrollment


Both individuals providing services and agencies employing individuals must complete provider enrollment process. The process includes these 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.