Provider Enrollment

Physician - Individual Billing Medicaid

If you do/will provide Medical Services and the services you provide will be billed to Medicaid by you or by a group practice, Click Here for the Enrollment Form and Instructions.

Physician - Order/Prescribe/Refer/Attend ONLY

Special Note for Attending Physicians:

Attending Physicians should complete the form below if their name/NPI will ONLY be found on a claim submitted by the Hospital. If the practitioner will be attesting for MEIPASS/EHR Incentive, do not apply as an OPRA provider.

If the Attending Physician or his/her Group will be billing Medicaid for the professional services of the Attending Physician, DO NOT complete the form below. Select the link in Option 1 above.

If you ONLY will Order/Prescribe/Refer/Attend and you will NOT be Billing Medicaid, Click here for the Enrollment Form and Instructions.

Physician - Change From OPRA To Billing Provider

If you are already enrolled as an Order/Prescribe/Refer/Attend (OPRA) Provider and wish to provide Medicaid Services and Bill Medicaid, Click here for the Enrollment Form and Instructions.