Enrollment Application

Monday, August 3, 2026

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(click to hide) Alert Message posted 5/25/2026

Provider Revalidation Deadline

The Department has identified providers who have not completed required revalidation in accordance with federal regulations. A list of these providers is available at: Provider Information > Reports for Public Access > Provider Revalidation Past Due.

Effective July 1, 2026, providers who have not revalidated will be suspended and unable to participate in Georgia Medicaid/PeachCare for Kids® programs, including Fee-for-Service, Georgia Families, and Georgia Families 360. Claims with dates of service on or after July 1, 2026, will not be paid.

Suspension will be lifted once revalidation is completed; however, the effective date will be the application submission date. Retroactive enrollment is not permitted. Providers who do not revalidate within 30 days of receiving a suspension notice will be terminated and provided with appeal rights.

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Welcome to the online Provider Enrollment application.

The enrollment application is a one source application for both fee-for-service Medicaid and CMO (Care Management Organization) enrollment.
You must complete each step in the Enrollment application. When you have completed all of the steps, including uploading all required supporting documentation, please click on the 'Submit' button to submit your application. The application is automatically saved after each step.
Fields marked with an asterisk (*) are required.
Please click the 'New Application' to start a new Provider Enrollment application or click 'Existing Application' to continue or withdraw an existing application.
Application Fee Information
42 CFR 455.460 requires that certain prospective (new), re-enrolling, or revalidating providers pay an application fee. Individual physicians or non-physician practitioners are exempt from the fee as well as those providers who have already paid the fee to a Medicare contractor or another State's Medicaid program. Section 105.3, Part I Policies and Procedures for Medicaid/Peachcare for Kids®, identifies the categories of service that are required to pay the application fee. Within thirty (30) days from the date of submission of an application, the Division may reject an enrollment application from a prospective (new) or re-enrolling individual or institutional provider that is not accompanied by the application fee or a letter requesting a hardship exception or waiver of the application fee.
Help is available by clicking the question mark (?) in the title bar.

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