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.