You receive the Submit Complete page when you have submitted your application successfully. It provides an application tracking number to be used when you are checking on the status of your application. You can print any listed documents to review. All required additional information can be sent to the address indicated.
The Submit Complete page contains the following panels and options:
| Field | Description |
|---|---|
| Application Tracking Number |
Number assigned to individual or group application. It is required when you check the status of your application either by phone or via the Web. It should also be written on all documents that are mailed in to support your application. |
| Trading Partner Application Number | Displayed only if vendor software information was completed on the Electronic Transaction Submission page. The number assigned to the trading partner application. It should also be written on all documents that are mailed in to support your application. |
| Links | Description |
|---|---|
|
Print Required Document Print the document listed for your review. The list of documents depends on the type of application being submitted. The following is an example of a commonly required document. |
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| Document Requirements Checklist | Prints a Document Requirements Checklist of supplemental items by provider type and business model that are needed to finalize your application. Mail them if specified in the checklist to the address on the page. |
| Medicaid Provider Participation Agreement | Prints the Medicaid Provider Participation Agreement for review. |
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To print a copy of the entire application you entered for your records, click Print Application. To exit the application and return to the Provider Enrollment Home page, click Exit Application. |
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Version as of 5/16/14.
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