Provider Enrollment is responsible for enrolling qualified providers to receive Medicaid reimbursement for services rendered to Medicaid recipients. Providers can enroll in the Florida Medicaid program online using the Enrollment Wizard or by downloading the Provider Enrollment Application via the Internet. Providers can also request the application using the address or the phone number provided below. The completed application and all applicable forms should be submitted to Provider Enrollment where they will be reviewed for accuracy. Upon completion of the enrollment process, approved providers are issued a nine (9) digit Medicaid provider number. The provider will then be able to participate in the Florida Medicaid program.
Provider Enrollment is also available to assist the provider with enrollment issues such as change of address, change of ownership, and re-enrollment issues.
Provider Enrollment can be reached at the following:
Address: Florida Medicaid Provider EnrollmentP. O. Box 7070Tallahassee, Florida 32314-7070
Phone:1-800-289-7799 Option 4
Providers use this page to complete an enrollment application to become a participating provider in the Florida Medicaid program. The application uses a wizard to guide applicants through the enrollment form. An in-progress application can be saved and completed at a later time.
Please reference the Provider General Handbook, Chapter 2, for general requirements that apply to most provider types when enrolling as a Florida Medicaid provider. Applicants must meet all the provider requirements and qualifications and their practices must be fully operational before they can be enrolled as Medicaid providers.
By clicking on the on-line enrollment wizard at the bottom of this page, you will be enrolling as a new Medicaid provider. Please reference the Provider General Handbook, Chapter 2, for general enrollment requirements. Applicants must meet all requirements and qualifications. Practices and facilities must also be fully operational before enrollment with Florida Medicaid will be allowed. Please do not begin seeing Medicaid patients until you have received verification of enrollment. Specific qualifications for each provider type are listed in the Coverage and Limitations Handbooks. Upon completion of the on-line enrollment wizard, any additional documents, as required by provider type, may be uploaded or faxed. If you choose to mail your documentation, please print and include a coversheet or indicate your Application Tracking Number on each document. Please remember, signature stamps are not acceptable.
Specific qualifications for each provider type are listed in service-specific Coverage and Limitations Handbooks.
The On-line Enrollment Wizard will assist with the completion of an application. Required documents, as stipulated in the applicable Handbook sections, may be uploaded with the application or faxed to Provider Enrollment at 866-231-8136. Include the Application Tracking Number (ATN) provided by the On-line Enrollment Wizard when uploading or faxing supporting documents. The application process cannot be completed until all required documents including an accurately completed Florida Medicaid provider agreement and background screening are received and matched with the online submission.
ON-LINE ENROLLMENT WIZARD