How to enroll as a medicaid provider - Robert Merced
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How to enroll as a medicaid provider

On screen 1 choose Enrollment

enrollment-1

On screen 2 taxonomy must be all CAPITAL LETTERS !

enrollment-2

On screen 3 just save and continue to skip

enrollment-3

On screen 4 just enter your business name, type of business and tax ID

enrollment-4

On screen 5  just save and continue to skip

enrollment-5

On screen 6 just enter the name of the main contact person for the business

enrollment-6

On screen 7 just enter your business address and info

enrollment-7

On screen 8 just enter your business address and info

enrollment-8

On screen 9 enter your mailing address and contact info

enrollment-9

On screen 10 enter the address where you want your checks mailed

enrollment-10

On screen 11 enter the address of your corporate office if you have one

enrollment-11

On screen 12 select I do not use a billing agent unless you do

enrollment-12

On screen 13 enter the owners information

enrollment-13

That’s it !

enrollment-14

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