You use the Download Enrollment Forms page to download an enrollment package for an individual or group provider, a Canadian application, or a Trading Partner. You must have Adobe Reader installed on your computer in order to do the download.
You can view an enrollment package for an individual or group provider, the form to add an additional service location for an individual or group provider, the frequently asked questions (FAQs) about enrollment, or the application form instructions. You must have Adobe Reader installed on your computer in order to do the download.
The Identifying Information page for downloading enrollment forms contains the Download Enrollment Forms panel.
| Field | Description |
|---|---|
| Please indicate the type of application you wish to download: |
Instructions to select the type of application enrollment form that you wish to download. Different forms are displayed, depending on the application selected. |
| Individual Application |
Select to download forms for an individual application. Note: If you select this option, you must select a Provider Type. |
| Group Application |
Select to download forms for a group application. Note: If you select this option, you must select a Provider Type. |
| Provider Type |
The type of provider for the application forms you are submitting. Examples: Chiropractor (Individual), Pharmacy (Group) |
| Canadian Application |
Select to download forms for a Canadian application. |
| Trading Partner Application |
Select to download forms for a Trading Partner application. |
Version as of 6/30/2015.
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