Dhs Provider Agreement Form
Description
How to fill out Anchor Provider Agreement?
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FAQ
In order to become eligible to participate in the Medicaid program, providers are required to either complete a provider enrollment agreement form or sign a contract with DHHS depending on what type of services they provide.
An UMPI is a 10-digit Unique Minnesota Provider Identifier that MHCP assigns to you at the time of your enrollment. You will receive your UMPI in your welcome letter confirming your enrollment.
How to ApplyPhone: 1-800-465-3203 or TTY 1-800-692-2326.E-mail: customerservice@npienumerator.com.Mail: NPI Enumerator. 7125 Ambassador Road Suite 100. Windsor Mill, MD 21244-2751.01-Dec-2021
After an individual or group provider meets professional certification and licensure requirements, you can apply to be an enrolled MHCP provider using the Minnesota Provider Screening and Enrollment (MPSE) portal or by submitting the application materials required for your services by fax.
Become a ProviderGo to the MITS Portal.Select the "I need to enroll as a provider to bill Ohio Medicaid" option.Follow the system prompts and provide the requested information.When you have completed all steps, please submit your application.