Welcome to the Online Provider Enrollment System
To start a NEW application please click the “Start” button in the bottom right corner to begin the enrollment process. The application will automatically save each time you click “Continue”.
To RESUME an application click
Here
To start a REVALIDATION click
Here
Enrolled providers: To request a contract with an MCO, Log into the
provider secure portal,
Navigate to the "Manage my information" section and select the MCO Network tab.
To check the STATUS of an application click
Here
List of staus descriptions:
Partial/Started - Application has been started but not yet been submitted or a revalidation* has been generated and requires the provider to complete the revalidation. (*Revalidation is a pre-populated application that needs to be reviewed by the provider and submitted.)
Awaiting Attachments - Application has been submitted but is waiting for required attachments/documents.
Submitted - Application is complete and has been submitted for review.
Pending - Application has been queued for the enrollment team for review.
RTP (Returned to Provider) - Application requires corrections. (Applicant will receive a separate notification identifying the specific issue(s) requiring attention.)
Approved - Application has been approved. (Applicant will receive written confirmation that the application has been approved. For newly-enrolling Providers, the Welcome Packet includes the Provider number and other program participation information.)
Expired - Application was not submitted within the allowable timeframe. A new application is required in this situation.
Submitted to Managed Care - Application has been forwarded to MCOs for contracting. (This status is used for KMAP-approved applications that have also requested to participate with additional managed care organizations.)
Please note that only one service location and one provider type can be enrolled per application. All attachments must be complete, legible and current. You will be notified if your application cannot be processed because it is incomplete or the information is incorrect.
Existing Group members (Individuals in a Group) only need to be enrolled once for each state in which they practice. Individual in a Group providers may affiliate to multiple organizations.
All providers may need the following minimum information to complete your enrollment request:
- Address information
- Tax Identification Number/Social Security Number
- W-9
- Application Fee
Additional information may also be required depending on provider type such as:
- National Provider Identifier
- Taxonomy code(s)
- License Number(s) and Effective Dates
- CLIA Number and Effective Dates – if billing laboratory codes
For general enrollment Frequently Asked Questions, click
Here
For any questions related to your application, call 800–933–6593.
