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Medicaid Provider Enrollment Requirements Fact Sheet

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WebCENTERS FOR MEDICARE & MEDICAID SERVICES Form Approved OMB No. 0938-0685 Expires: 08/19 WHO SHOULD COMPLETE THIS APPLICATION Institutional providers can apply for enrollment in the Medicare program or make a change in their enrollment information using either: • The Internet-based Provider Enrollment, Chain and Ownership … WebInitial applications for most provider types may also be submitted online. To avoid having your application and payment returned: Make check/money order payable to Agency for … WebIndividuals - People looking to apply for benefits, learn more about Medicaid programs, or find help. Providers - Health care providers who are enrolled with Medicaid or would like to … forcing math