#N#Please complete each of the steps in the enrollment process. DHS-2351-X, Bridges Provider Enrollment/Change Request Subject: Bridges Provider Enrollment/Change Request Author: Michigan Department of Health and Human Services Keywords: MDHHS DHS-2351-X Bridges Provider Enrollment Change Request Last modified by: Simmons, Scott (DTMB) Created Date: 10/1/2018 7:51:00 PM Company Complete an IHCP Provider Enrollment Application Enrollment transaction submissions are needed to enroll, add a service location, report a change of ownership, revalidate, or update provider profile information. Version: 02.22.00 Build: 1 Deployment Date: 9/14/2012 7:16:38 AM Questions? Provider Enrollment for the Childhood Vaccine Program Each year, providers must renew their Provider Agreement for the Receipt of Publicly Supplied Vaccine. Welcome to the online Provider Enrollment process. In May 2013, providers began using the Washington State Immunization Information System (IIS) to complete their annual enrollment.
Click the Contact Us link above When you have completed all of the steps please click on the "Save" button to submit your application. You can choose from 4 plans in all counties and 6 plans in Cook County. Upon arrival, the OHCA representative will ask the provider questions, review various aspects of the provider's business and view the facility. This will eliminate the need for providers to submit paper enrollment requests. If you have an HFS medical card, you will be required to pick a managed care health plan. Special Needs Children in HealthChoice Illinois. Address: Department of Human Services Procurement Office Attn: Nawania Williams 700 Main Street, Slot W345 Little Rock, AR 72201 RFI_19-0001_Provider_Enrollment.docx About DHS The Minnesota Provider Screening and Enrollment (MPSE) portal is a new web-based application that allows providers to submit and manage their Minnesota Health Care Programs (MHCP) provider enrollment records and related requests online. Non-cooperation with the OHCA representative could affect the provider's enrollment.
(See the General Agreement and Special Provisions per specialty.) #N#If you need additional assistance completing the steps of the application, please click the Help on the header menu. If you have any questions about completing an electronic enrollment application, please call the appropriate phone number shown on the Important Phone Numbers and Addresses page of this site. The IHCP provider enrollment instructions and processes are outlined on these web pages. Enter your application tracking number (ATN), Federal Tax Identification Number (FEIN or SSN) and password in order to review your application status.


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