Provider Enrollment Page
You use the Provider Enrollment page to enter new individual billing, non-billing or group enrollment applications, enter trading partner applications, check on the status of the saved applications, recall applications, obtain instructions, access frequently asked questions, and download enrollment packages. If you are individual or group provider you also can request an enrollment package in the mail. See What Is Provider Enrollment?
The Provider Enrollment page consists of the following links and panels:
- Become a Billing Provider
- Become a Non-Billing Provider
- Become a Trading Partner
- Application Status
- Recall Provider Application
- Recall Trading Partner Application
Become a Billing Provider Links
| Field | Description |
|---|---|
| FAQ | Displays the Provider Frequently Asked Questions page. Then you can select the appropriate FAQ to review or print. |
| Instructions | Displays the Instructions page containing links to select the instructions you want to print. |
| Group Provider Enrollment | Provides general instructions for the group provider before starting the application process. To enter the group provider enrollment, click Continue. |
| Individual Provider Enrollment |
Provides the general instructions for the individual provider before starting the application process. To enter the provider enrollment, click Continue. |
Become a Non-Billing Provider Links
| Field | Description |
|---|---|
| FAQ | Displays the Provider Frequently Asked Questions page. Then you can select the appropriate FAQ to review or print. |
| Instructions | Displays the Instructions page containing links to select the instructions you want to print. |
| Non-Billing Rendering Provider Enrollment | Provides general instructions for the non-billing rendering provider before starting the application process. To enter the non-billing rendering provider enrollment, click Continue. |
| Non-Billing ORP Provider Enrollment |
Provides the general instructions for the non-billing ORP provider before starting the application process. To enter the non-billing ORP provider enrollment, click Continue. |
Become a Trading Partner Links
| Field | Description |
|---|---|
| FAQ | Displays the Provider Frequently Asked Questions page. Then you can select the appropriate FAQ to review or print. |
| Instructions | Displays the Instructions page containing links to select the instructions you want to print. |
| Trading Partner Enrollment | Provides general instructions for the trading partner before starting the application process. To enter the trading partner enrollment, click Continue. |
Application Status Field
| Field | Description |
|---|---|
| Application Tracking # |
The tracking number received when the application was saved. |
Recall Provider Application Fields
| Field | Description |
|---|---|
| Application Tracking # |
The tracking number received when the application was saved. |
| SSN/FEIN | The provider's social security number or Federal Employer Identification number. |
Recall Trading Partner Application Fields
| Field | Description |
|---|---|
| Application Tracking # |
The tracking number received when the application was saved. |
| SSN/FEIN | The trading partner's social security number or Federal Employer Identification number. |