Provider Enrollment

If you do/will bill fee-for-service (FFS) Medicaid, click here for the Enrollment Form and instructions.


Please note: If you will NOT be billing FFS Medicaid, select Option 2 below

Nurse (LPN/RN) — Non Billing (Managed Care Network) Provider

If you will NOT be billing fee-for-service (FFS) Medicaid, click here for the Enrollment Form and instructions.


If you do/will bill FFS Medicaid, select Option 1 above

Nurse (LPN/RN) — Change From Non Billing (Managed Care Network) Provider To Billing Provider

If you are already enrolled as a Managed Care Network Provider and wish to bill fee-for-service Medicaid, click here for the Enrollment Form and instructions.

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