Search   Saturday, May 2, 2026 Skip to Provider Enrollment Subsystem Menu Home Publication Search Site Map Site Settings Language Selection |  Contact Information Contact Us Phone Numbers & Links |  Member Information Find a Provider Notices and Publications Register for Secure Access |  Provider Information Provider Notices Provider Manuals Provider Messages Fee Schedules Forms for Providers Reports for Public Access FAQ for Providers Web Portal Training Provider Education |  Provider Enrollment Enrollment Application Status Enrollment Wizard Provider Contract Status EFT Agreement Enrollment Forms |  EDI Submitter Information Companion Guides and Manuals Vendor List Registration Forms FAQ for EDI |  Pharmacy Pharmacy Notices Pricing List Medicare Updates Other Documents Prior Approval Process Home Enrollment Application Status Enrollment Wizard Provider Contract Status EFT Agreement Enrollment Forms (click to hide) Alert Message posted 4/30/2026 Group Enrollment Group Enrollment is now open! Go to the Provider Enrollment Application under the Provider Enrollment menu option Select the Group/Billing Application Type Enter your group information, including affiliating your rendering providers Enter your existing Payee Medicaid ID on the Payee panel Claims may be denied if your group is not enrolled before the claim edit is enforced. Enforcement is projected to start on July 1, 2026. » User Information    Login/Manage Account Login/Manage Account Login Instructions>Search>Request Type>Provider>Contract>Specialty>Physician Specialty>ASL>Detail>Group Detail>Address>Bed>Pharmacy>Medicaid>Language>Special Need>Admit Privileges>License>Permit>Certification>Affiliations>Owner>Addtl Owner>Addtl Address>Fingerprint>Employee>Subcontractor>Rate>Staff>Sponsoring>Supervising>Payee>Hours>Access>Education>Training>Work>Insurance>Programs>Waiver>History>History CVO>Facility History>Doco>Autism Attest>ROI>SOP>Policy Attest>Attestation> » Instructions       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.    exit new application existing application    English | Español | Accessibility | Privacy | AMA & ADA Copyright © Copyright 2026 Gainwell Technologies