|Provider Enrollment - New
|This page will be accessed through the Public Web Site Provider page. It must be used by providers to submit enrollment applications through the Web.
Navigation Path: [Provider] - [Provider Enrollment]
- The purpose of the Provider Enrollment process on the Internet is to allow the provider to submit an enrollment application for the Connecticut Medical Assistance Program on the Public Web Site.
- Access to this application does not require a log on: any user who has Internet access can utilize this application. The Web application collects the entered provider enrollment data and forwards it to the review process.
- The Internet provider enrollment process begins when the provider opens the provider enrollment Web page from the hot link or the Provider menu.
- The provider will be prompted through a series of steps to complete data required to submit the appropriate application for review and approval.
- As the data is entered, the data is edited for validity. If errors are detected, the provider will be prompted with an error message to correct the entry
before they are allowed to complete the application. At the completion of
the application, the application is assigned an Application Tracking Number
- Providers have the opportunity to print or save a copy of the completed application.
Please do not submit a paper copy of the Web application to DXC Technology.
- Providers may also be required to submit some follow on documentation to
the on-line portion of the Web application. This varies by provider type.
Providers are notified at the end of the on-line Web application which
follow on documents are required and how those are to be submitted to DXC Technology.
- The Internet re-enrollment process begins when the provider receives the
re-enrollment notification letter.
|Enrollment Wizard Panel Helpful Hints
- On all panels, click the Next button to validate the current panel data and move to the next step. Click the Previous button to move back to the previous panel. Click Exit to leave the application - changes will not be saved. Click Add or Delete to add new entries to the panel or delete an existing entry from the panel. All End Date fields should be populated. If an exact End Date is not known, use the value of 12/31/2299 for an End Date entry.
- To view an example of a completed online application, click on the link
to the applicable enrollment application sample on the Before You Continue
panel after entering the provider type and specialty.