How to Enroll Online or By Mail

You can enroll to become a provider either online or by mail:

To become a provider online

1. Do one of the following:
   • On the Provider menu, click Enrollment.
   • On the Quick Links pod on the public Home page, click Provider Enrollment.
2. Choose the appropriate category through which you want to become a provider (categories include individual provider, group provider, and trading partner).
3. Complete the application, being sure to include all the required information (an *asterisk indicates required fields).
4. Submit your application, mail or upload any other necessary documentation, and print the application for your records.

To become a provider by mail

1. Do one of the following:
   • Download a provider enrollment package (PDF format) that is appropriate to how you want to enroll.
   • Request a provider enrollment package by mail.
2. Once you have your application, complete the documents, being sure to include all required information.
3. Mail the Provider enrollment package and any other necessary documentation in using the address provided.

See Also

Version as of 6/30/2015.