Provider Enrollment

Nurse (LPN/RN) — Individual Billing Medicaid

If you do/will bill fee-for-service (FFS) Medicaid, click here for the Enrollment Form and instructions.

Nurse (LPN/RN) — Non Billing (Managed Care Network) Provider

If you will NOT be billing fee-for-service (FFS) Medicaid, click here for the Enrollment Form and instructions.

Nurse (LPN/RN) — Change From Non Billing (Managed Care Network) Provider To Billing Provider

If you are already enrolled as a Managed Care Network Provider and wish to bill fee-for-service Medicaid, click here for the Enrollment Form and instructions.