What are the different enrollment types?

Once you are a registered provider, you can select one of the following enrollment types:

  • Individual enrollment – This is an individual provider or health care practitioner who provides services to Medicaid members.
  • Group enrollment – A group provider consists of two or more health care practitioners, whose practice is incorporated under the same tax identification number, a  Federal Employer Identification Number (FEIN).
  • Provider Enrolment Manager (PEM) – A PEM is a representative for one or more providers. PEMs can submit enrollments, revalidations, re-enrollments, appeals, and Change of Circumstance (CoC) requests, on behalf of providers.
  • Facility – A facility provider can be a Hospital, Long-term Care Facility, Clinic or a Laboratory who provides services to Medicaid members.
  • Pharmacy – A provider who supplies medications to Medicaid members.
  • Ordering/referring/prescribing provider enrollment – An Ordering, Referring or Prescribing (ORP) provider is a provider type that does not participate (for billing purposes) in Medicaid, but may order, refer or prescribe.

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