Online Panel Help
Provider Re-Enrollment
This page will be accessed through the Public Web Site Provider page. It must be used by providers to submit re-enrollment applications through the Web, once the provider is notified that it is time to re-enroll.

Navigation Path: [Provider] - [Provider Re-Enrollment]
  • The purpose of the Provider Re-Enrollment process on the Internet is to allow the provider to submit a re-enrollment application for the Connecticut Medical Assistance Program on the Public Web Site.
  • Access to this application requires an Application Tracking Number (ATN) and the provider's National Provider Identifier (NPI)/Non medical provider identifier (AVRS ID).
  • The provider will be prompted through a series of steps to validate their data that currently exists in the Connecticut Medical Assistance Program's system.
  • 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. 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.