Get the up-to-date Medicaid Provider Enrollment Application and Agreement 2024 now

Get Form
Medicaid Provider Enrollment Application and Agreement Preview on Page 1

Here's how it works

01. Edit your form online
01. Edit your form online
Type text, add images, blackout confidential details, add comments, highlights and more.
02. Sign it in a few clicks
02. Sign it in a few clicks
Draw your signature, type it, upload its image, or use your mobile device as a signature pad.
03. Share your form with others
03. Share your form with others
Send it via email, link, or fax. You can also download it, export it or print it out.

The best way to modify Medicaid Provider Enrollment Application and Agreement in PDF format online

Form edit decoration
9.5
Ease of Setup
DocHub User Ratings on G2
9.0
Ease of Use
DocHub User Ratings on G2

Handling paperwork with our feature-rich and intuitive PDF editor is easy. Make the steps below to complete Medicaid Provider Enrollment Application and Agreement online quickly and easily:

  1. Log in to your account. Log in with your credentials or create a free account to test the service before choosing the subscription.
  2. Import a form. Drag and drop the file from your device or add it from other services, like Google Drive, OneDrive, Dropbox, or an external link.
  3. Edit Medicaid Provider Enrollment Application and Agreement. Quickly add and highlight text, insert images, checkmarks, and icons, drop new fillable fields, and rearrange or delete pages from your document.
  4. Get the Medicaid Provider Enrollment Application and Agreement accomplished. Download your updated document, export it to the cloud, print it from the editor, or share it with other people via a Shareable link or as an email attachment.

Take advantage of DocHub, the most straightforward editor to promptly manage your paperwork online!

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.
Contact us
Enrollment questions may be directed to the Medicaid Enrollment Unit by telephone at 800-343-9000 or by email providerenrollment@health.ny.gov. MMC plan contact information can be found on the NYS DOH New York State Medicaid Managed Care (MMC) Pharmacy Benefit Information Center homepage.
Telephone Service Center 1-800-541-5555 The Telephone Service Center (TSC) is available from 8 a.m. to 5 p.m., Monday through Friday, except holidays.
If you are a provider type not yet eligible to submit an application via PAVE, you can request that a Medi-Cal enrollment application be mailed to you by calling the Medi-Cal Provider Service Center at (800) 541-5555(outside of California, please call (916) 636-1980).
(800) 977-2273​ Medi-Cal Rx ​Members and Providers: If you have a question, need help, or need to report a problem, please call (800) 977-2273 for our Medi-Cal Rx Customer Service Center (CSC)​. CSC hours are available 24 hours a day, 7 days a week, 365 days a year.
How to Enroll. Go to the Enrolling in the CSHCN Services Program page of the Texas Medicaid Healthcare Partnership website. You can enroll online or print out the paper application form to complete and return to TMHP. If you have questions, call your local area TMHP provider relations representative.
be ready to get more

Complete this form in 5 minutes or less

Get form

People also ask

How do I apply? Apply online at mymedicaid-florida.comopeninnew. From the home page, hover over Provider Services and select New Medicaid Providers under the Enrollment section. If you are a network health care professional for other Florida Medicaid health plans, you only need to submit 1 application.
To verify enrollment with State Medi-Cal, you may search the Department of Health Care Services (DHCS) database via one or both of the links below (Enter your National Provider Identifier (NPI) in the search field).