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Dakotacare information ens 2026

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The DakotaCare Enrollment Form is a required document for providers to complete and submit for approval before sending electronic claims through Secure EDI. It includes sections for provider information, such as name, EIN/SSN, address, and contact details. Completed forms should be mailed to the specified address, and inquiries can be directed to the Enrollment Department.

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Click ‘Get Form’ to open the DakotaCare Enrollment Form in the editor.
Begin by entering the 'Provider/Group Name' in the designated field. This is essential for identifying your practice.
Next, provide your 'Provider EIN/SSN'. Ensure accuracy as this information is crucial for processing.
If applicable, fill in the 'Group Provider Number'. This helps in associating multiple providers under one group.
Complete the address section by entering your 'Address', 'City, State, Zip'. This ensures correspondence reaches you correctly.
Identify a 'Contact Person' and include their 'Phone Number' for any follow-up inquiries regarding your submission.
Indicate whether you are providing an EIN or SSN by checking the appropriate box.
Lastly, enter your fax number if applicable, ensuring all communication channels are open.

Start filling out your DakotaCare Enrollment Form today for free and streamline your document process!

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