Enrollment Options


Option 1: Provider Ownership Enrollment Web Application

  • The process is designed to report ownership information electronically
  • Using the Provider Ownership Enrollment web application is secure, effective, and fast
  • Using the Provider Ownership Enrollment web application to report ownership data eliminates rejection of enrollment application due to improperly reported ownership data
  • Use the Provider Ownership Enrollment web application to download your enrollment packets
  • This link is currently under construction. Please continue by using Option #2 below as the Disclosure of Ownership document is included in the Basic Enrollment Packets.

Option 2: Provider Enrollment Packets Link

Click here for a list of provider enrollment packets that you may download, fill out, and submit via U.S. Mail.