Provider Application Information And Forms
All providers are required to apply for enrollment electronically on the ND Health Enterprise MMIS portal. Exceptions are HCBS/QSP and NEMT providers.
The information below is for electronically submitted North Dakota Medicaid applications using ND Health Enterprise MMIS Web Portal. A printable PDF version is linked below for reference/distribution.
ND Health Enterprise MMIS offers providers a user-friendly self-service web portal that has new features and benefits.
- Use the MMIS web portal now to enroll electronically. This is required for all new and existing providers with the exception of Individual Qualified Service Providers and Developmental Disability Providers.
- Use the MMIS web portal to directly enter claims, upload batch transactions, and get real-time access to member eligibility, claims status, remittance advice, payment status and claims history.
- Enrolling as a Qualified Service Provider.
ALL DOCUMENTATION SUBMITTED MUST INCLUDE THE APPLICATION TRACKING NUMBER FROM THE ONLINE ENROLLMENT APPLICATION.
Provider Eligibility And Compliance
Responsible for ensuring the continued eligibility of enrolled providers through research and validation of providers who are excluded from participation in Medicare, Medicaid, or other federally-funded programs documenting justifications for exclusions from Florida Medicaid coordinating with Medicaid Program Integrity and the OGC regarding referrals for legal sanctions monitor provider background screening processes taking appropriate actions when providers have disqualifying offenses participate on the Clearinghouse Advisory Board coordinate with Medicare related to mismatches in provider data between PECOS and the MMIS coordinate requests for onsite reviews with the RPA Onsite Review Desk perform change of ownership reviews, including determining if there is any pending enforcement action by MPI or MFCU, verify accuracy of ownership disclosures, and identify any money owed by the seller or the buyer and participate in an interagency workgroup on provider license compliance.
Providers Subject To On
Federal and state laws require some providers to have pre- and post-enrollment on-site screening visits to ensure program integrity. .
In Ohio, the Public Consulting Group, Inc. will conduct these visits for providers that are not already screened by another state or federal agency. On-site screening visits are conducted without prior notification or appointment. The PCG representatives will have a business card and a letter of introduction, for your verification.
When the PCG representatives arrive at your office, please take a few moments to answer their questions and allow them access to your facility. This will help to complete your on-site visit smoothly. During your site visit, the PCG representatives will review various aspects of your business. Failure to answer their questions and cooperate with the PCG representatives could affect your enrollment or current provider status with Ohio Medicaid.
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Providing A Medical Home For Clients
Providers are the crucial players in any quality health-care program. Providers enrolled with Texas Medicaid and other health-care programs render essential medical and preventive health-care services to clients while focusing on providing the best medical care possible. Texas Medicaid providers help ensure that each patient can receive high quality, comprehensive health-care services within their community.
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Provider Business Module Management
Responsible for the business of provider enrollment. Staff will design, develop, and implement solutions for provider regulation compliance through close coordination with the Centers for Medicare and Medicaid Services, the Office of the Inspector General, and Medicaid Program Integrity, and other states’ Medicaid programs coordinate with internal and external partners in support of the Medicaid Enterprise System and operational processes participate in development and implementation of system enhancements through close working relationship with the fiscal agent represent the Agency on national meetings and work groups related to provider screening develop operational process standards through process mapping develop reporting mechanisms to manage Provider Enrollment Unit workloads and data anomalies document regulatory requirements and proof of compliance provide transparency to Provider Enrollment Unit activities assist Medicaid Policy and Publication Units with maintenance of provider guides, training materials, and rule documents and design, develop, and implement fiscal agent monitoring processes and reporting mechanisms in support of contract enforcement, including the use of CAPs and sanctions to enforce compliance.
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Enrolling As A Trading Partner
Once you are enrolled as a provider in RI Medicaid, you must apply for a Trading Partner ID to access eligibility, claim status and remittance advice. Applicants may access the electronic enrollment process by visiting the RI Healthcare Portal.
All existing Trading Partners are required to register in the Healthcare Portal. Instructions are found on the Healthcare Portal page.
Ihcp Quick Reference Guide
The best way to find the correct Indiana Health Coverage Programs contact information is to check the . Whether your question or need relates to members or providers managed care or fee-for-service coverage medical, pharmacy or other service type, the IHCP Quick Reference Guide can help with resources for enrollment, claims, prior authorization and more. The guide also provides the telephone number for IHCP Customer Assistance.
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New Services Are Being Added To Ohio Home Care Waiver
Effective July 1, 2019, three new home and community-based services will be available to individuals enrolled on the Ohio Home Care Waiver. The new services are Community Integration, Community Transition and Home Maintenance/Chore. To find out more about the services and determine if or how you can become a provider. .
National Provider Identifier Information
- Healthcare Provider Taxonomy Code Set – Visit CMS Taxonomy webpage for a link to the taxonomy code set when applying for an National Provider Identifier .
- National Plan and Provider Enumeration System Home Page – See NPPES for information required during the MaineCare enrollment process.
- NPI Application Help Page – Go to this webpage for help with the CMS application for the NPPES registration process.
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Attention Waiver Services Provider Applicants
Prior to submitting an application, waiver provider should contact the following for enrollment requirements and assistance:
- For the Ohio Home Care Waiver Visit: for application and enrollment information or contact PCG at 908-1746. Note: Bureau of Criminal identification & Investigation reports for initial provider enrollments ONLY should be sent to: The Ohio Department of Medicaid, Attention: BCII Coordinator, P.O. Box 183017, Columbus, Ohio 43218-3017
- For Passport or Assisted Living waiver programs Visit: for application and enrollment information.
- For Individual Options, Level 1 and SELF waivers – Visit the DODD Gateway: .
How To Become A Mississippi Medicaid Provider
To enroll as a Mississippi Medicaid provider, you have two submission options:
These application methods are located under Provider on the Envision website along with the enrollment requirements for each provider type.
The Envision website lists the application instructions and steps to become a Medicaid provider, required documentation and necessary forms. You can also check your provider enrollment status, download a change of address form and a primary care provider attestation form.
If you have any questions about the enrollment application and/or process, contact a Conduent provider enrollment specialist toll-free at 800-884-3222.
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Become A Medicaid Provider
Thank you for your interest in participating as a Medicaid provider. To become a Medicaid provider, you must complete the PRISM online enrollment and submit the required forms and documents. If you do not wish to be reimbursed by Medicaid for your services but would still like to order, refer or prescribe to Medicaid members, you will still need to complete the PRISM online enrollment.
Creating a Utah ID Account
A provider will have to register with the State of Utah by creating a Utah-ID Account. If you have a Utah-ID and password, simply log in to access the PRISM Portal. for more information and instructions if you have not previously created a Utah-ID account.
Starting April 1, 2021, providers will need to go through a multi-factor authentication process to access the PRISM application. Please visit the links below for additional information:
Get Important News & Updates
Sign up for email and/or text notices of Medicaid and other FSSA news, reminders, and other important information. When registering your email, check the category on the drop-down list to receive notices of Medicaid updates check other areas of interest on the drop-down list to receive notices for other types of FSSA updates.
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Getting Started With Enrollment
The Provider Enrollment Online Application is a user-friendly web application that gathers all the information needed to enroll you or your organization as a licensed Medicaid provider in North Carolina. The following information will help you get started with your application. read on Getting Started With Enrollment
PDF documents on this page require the free Adobe Reader to view and print.
This page includes a list of answers to frequently asked questions and other resources regarding provider fingerprint-based criminal background checks. read on Fingerprinting Information Page
Change In Background Checks For Ohio Home Care Waiver Providers
Ohio Department of Medicaid is moving to a new system that will eliminate the need for Ohio Home Care Waiver non-agency providers to do an annual criminal records check. Over the next several months, we will be switching to RAPBACK or Retained Applicant Fingerprint Database. This new process will provide ODM continuous information about a persons criminal history. As a result, providers will no longer have to pay for a background check. ODM will automatically enroll providers into RAPBACK and there is no cost to the provider. There are a few people that will have to complete one more background check before they can be enrolled in RAPBACK. If you have any questions, please contact the Provider Hotline at 1-800-686-1516.
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Plan And Provider Enrollment And Outreach
Responsible for assisting plans and providers with the provider enrollment process, both initial and renewal submitting provider maintenance to the Medicaid fiscal agent receiving, tracking, and monitoring escalated issues, legislative requests, and public records requests performing onsite reviews coordinating and delivering plan and provider trainings related to provider enrollment providing support for new plan enrollments under SMMC procurement, and coordinating with external agencies, including APO and DOH, regarding provider enrollment.
Welcome To The Pennsylvania Department Of Human Services
Medical Assistance and Children’s Health Insurance Program On-line Provider Enrollment Application
In order for providers to participate with the Department of Human Services, they must first enroll. To be eligible to enroll, practitioners in Pennsylvania must be licensed and currently registered by the appropriate state agency. Out-of-state practitioners must be licensed and currently registered by the appropriate agency in their state and they must provide documentation that they participate in that states Medicaid and/or CHIP program. Other providers must be approved, licensed, issued a permit, certified by the appropriate state agency, or if applicable certified under Medicare.
To enroll, providers can complete an on-line provider enrollment application and supply any required supporting documentation. This includes providers who are not billing PA Medicaid or CHIP but provide services to beneficiaries. All applications will be screened based on Federal and State guidelines prior to an enrollment decision. Please retain copies of your application materials for your records. You will receive a response upon approval or denial of your enrollment with PA Medicaid and/or CHIP.
Types of Provider Enrollment ApplicationsThere are three types of enrollment applications and each requires a provider to complete an entire application. Please click the appropriate navigation item on the left hand side of the page to start a New Application, Revalidation or Reactivation.
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Fees And Surety Bonds
Providers who are newly enrolling, revalidating, or adding new practice locations with MaineCare must pay an application fee. This fee varies from year to year.
Home Health Agencies and Durable Medical Equipment providers are required to provide surety bonds when enrolling as a new provider, revalidating, or adding a new service location.
Instructions For Enrollment As A Medicaid Provider
Provider Enrollment in RI Medicaid has changed!
Beginning July 30, 2015, provider enrollment for the RI Medicaid Program is completed electronically through the Enrollment Portal, in the Healthcare Portal. Paper applications are no longer accepted except for attending physicians being added to an existing group.
It is important to note the following:
- Instructions for completing the electronic application are accessible on the homepage of the Healthcare Portal.
- Attending providers being added to a group will continue to submit a paper application found below.
- Effective October 1, 2015, Ordering, Prescribing and Referring providers must be enrolled in the RI Medicaid program to order, prescribe, or refer items or services for Medicaid beneficiaries. For more information on the claim types impacted or claims processing information, please review the Frequently Asked Questions document.
If you have any questions, please contact the Customer Service Help Desk at 784-8100.
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Promoting Continuity Of Care
When families are faced with unemployment or loss of employer-based health coverage, they turn to Texas Medicaid or another health-care program to provide the health care they and their loved ones need. Providers who enroll as Texas Medicaid and other state health-care programs providers can continue to see existing patients during those times of change.
Providers may also render service to families with mixed coverage .
Other Ways You Can Contact Us
Note: It is advised that you do not email forms with protected health information or personally identifiable information to protect your confidentiality. If you choose to return your forms by email, it is advised that you send the email securely . When unencrypted emails are sent over the Internet the email may be accessible by a third party and read.
- General Inquiry Form download the PDF form, either fax or mail it to DOM
Enrolling As A Medicaid Managed Care Organization Provider:
Providers interested in enrolling with Medicaid Managed Care Organizations are advised to contact MCOs directly via links below. All questions regarding enrollment and/or credentialling should be directed to MCOs.
- Neighborhood Health Plan of Rhode Island –
- Tufts Health Public Plans – Provider Services call center at 844.301.4093 can answer any questions, direct providers to the appropriate forms to initiate the credentialing process and provide status on previously submitted requests. The Provider page on Tufts Health Plan website, , contains hyperlinks to the required forms and provides an email address and fax number for submission of completed forms.
- United Healthcare –