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Provider Enrollment Information
 
Reporting Group Member Information and Group Affiliations

Medicaid-enrolled organizations and clinics (i.e., group providers) are required to report all individual Medicaid-enrolled providers working for the organization or clinic (i.e., group members) to ForwardHealth. In addition, individual Medicaid-enrolled providers are required to report all Medicaid-enrolled organizations and clinics for which they work (i.e., group affiliations). This information must be reported during initial enrollment, when revalidating enrollment, and any time a change occurs.

Each Group and Individual Provider Is Responsible for Reporting Group Member Information or Group Affiliations

Each group and individual provider is responsible for reporting their own group member information or group affiliations. When an organization or clinic reports its group members, the group affiliations of those individual providers are not automatically updated; similarly, when an individual provider reports his or her group affiliations, the group member information for those organizations or clinics is not automatically updated.

Requirements for Organizations and Clinics
Reporting Group Member Information During Initial Enrollment and Revalidation

During initial enrollment and revalidation on the Portal, organizations and clinics complete a Group panel. On this panel, organizations and clinics enter the National Provider Identifier (NPI) or Medicaid ID of each group member.

Reporting Changes in Group Member Information

Medicaid-enrolled organizations and clinics enter or update group member information using the demographic maintenance tool. Group member information must be entered or updated any time a change occurs (e.g., a new provider joins or leaves the organization or clinic). Medicaid-enrolled organizations and clinics are strongly encouraged to provide this information prior to revalidation to ensure ForwardHealth has the most current information on file.

Note: Changes made to group member information do not impact other demographic information ForwardHealth has on file for the organization or clinic (e.g., address or payee information).

Requirements for Group Providers
Reporting Group Member Information During Initial Enrollment and Revalidation

During initial enrollment and revalidation on the Portal, group providers are required to enter at least two actively enrolled individual providers employed by the group on the Group panel. On this panel, group providers enter the National Provider Identifier (NPI) or Medicaid ID of each group member.

Reporting Changes in Group Member Information

Medicaid-enrolled group providers are required to enter or update group member information using the demographic maintenance tool. Group member information must be entered or updated any time a change occurs (e.g., a new provider joins or leaves the group).

Note: Changes made to group member information do not impact other demographic information ForwardHealth has on file for the organization or clinic (e.g., address or payee information).

Requirements for Individual Providers Working for an Organization or Clinic
Reporting Group Affiliations During Initial Enrollment and Revalidation

During initial enrollment and revalidation on the Portal, individual providers complete a Group Member panel. On this panel, individual providers enter the NPI or Medicaid ID of each group with which they are affiliated.

Reporting Changes in Group Affiliations

Individual Medicaid-enrolled providers enter or update information about their group affiliations using the demographic maintenance tool. Information about group affiliations must be entered or updated anytime a change occurs (e.g., the provider joins or leaves a new clinic). Individual Medicaid-enrolled providers are strongly encouraged to provide this information prior to revalidation to ensure ForwardHealth has the most current information on file.

Note: Changes made to information about group affiliations do not impact other demographic information ForwardHealth has on file for the individual provider (e.g., address or payee information).

Keeping Information Current

Providers are required to notify ForwardHealth of any changes to demographic information as they occur. Group and individual providers are required to use the demographic maintenance tool to report these changes. Entering new information on a claim form or prior authorization request is not adequate notification.

 
 
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