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Provider Revalidation
Active providers submitting a Provider Enrollment Package for Revalidation must follow these steps:
- Click here for instructions and a new Revalidation Cover Page.
- Attach the Revalidation Cover Page to the appropriate Provider Enrollment Package (available in the dropdown below).
Important: Revalidation requests cannot be processed without the Revalidation Cover Page attached to the Provider Enrollment Package.
For questions regarding the Revalidation process, contact the Gainwell Technologies
Contact Revalidation Unit at 1-833-909-1522, Monday–Friday, 8:00 AM to 5:00 PM.
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Providers who are New or Not Active (including those previously canceled or disenrolled) can submit the appropriate Provider Enrollment Package without attaching the Revalidation Cover Page to become active in the Medicaid Program.
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Attention Newly Enrolling Providers
Certain provider types now have updated application packages, including a consolidated application cover page to streamline enrollment. Enrollment criteria have not changed.
The updated consolidated applications are available for groups and individuals:
- Advanced Practice Nurses
- Chiropractors
- Dentists
- Midwives
- Optometrists
- Physicians
- Podiatrists
- Psychologists and other psychotherapists (including LCSW)
For assistance with Provider Enrollment:
Contact Provider Enrollment at 609-588-6036 Monday–Friday, 8:00 AM to 5:00 PM
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