How to Become a Medicaid Waiver Provider
Instructions
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Contact your state's Department of Human Services for help obtaining the Medicaid Waiver Provider application. In some states, you can download the application directly from the Medicaid website by visiting the provider section.
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Fill-out basic identification information. You will need to provide basic information about who you are and how you can be reached. Provide your tax identification number by entering either your Socials Security number or Federal Employer Identification Number. Include your address, phone number and business email address.
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Answer questions about the type of provider you are. You will need to enter your provider code, practice type code, category of service, specialty code and license information. Enter your Medicare number. The application will also ask you to certify the business ownership. For example, the Florida Medicaid Provider application requires you to check whether 50 percent of the business is owned by physicians or a nonprofit hospital.
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Sign and complete the billing agreement. You will need to agree to the terms stated.
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Choose your preferred payment method. You can have funds electronically deposited into your checking or savings account. Provide bank account information, including your account and routing number.
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Mail the application along with requested documentation. You will need to mail copies of your licenses and identification. If additional documents are required, you will be contacted.
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