What Is Provider Enrollment?

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What Is Provider Enrollment?

Provider Enrollment allows individual or group providers of institutional, professional, or dental services to enroll in the Medicaid program. You must be enrolled in the Medicaid program before obtaining healthcare information about members or submitting claims and service authorizations online or electronically.

A provider is categorized according to the following:

Provider Category	Description
Individual Provider	An individual or sole proprietorship that is a state certified provider and reports income under a Social Security number, but does not have an employer identification number (EIN).
Group Providers	A group or incorporated individual that is a state certified provider and has an employer identification number (EIN) under which income is reported.
Trading Partners	Billing agents or business entities that transmit and receive electronic transactions on the behalf of a provider, provider group or carrier.

Once enrollment is complete, letters are automatically sent by mail to notify you when your application is pending, approved, denied, or terminated, and to notify you if your license must be re-certified or information must be verified. Once approved as an enrolled provider, you are issued a Medicaid ID number and you can begin to submit claims.

For Individual and Group Providers

If you are an individual or group provider, please select the area where you want help:

For Trading Partners

Provider enrollment also allows billing agents, carriers, clearinghouses, providers, other payers, and switch vendors to enroll as trading partners to transmit and receive transactions electronically. If you are a trading partner, please select the area where you want help: