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

Medicaid-enrolled organizations and clinics (group providers) are required to report all individual Medicaid-enrolled providers working for the organization or clinic (group members) to ForwardHealth.

In addition, individual Medicaid-enrolled providers are required to report all Medicaid-enrolled organizations and clinics for which they work (group affiliations).

Providers are required to report this information during initial enrollment, when revalidating enrollment, and any time a change occurs.

Group Member Information and Group Affiliations Are Not Automatically Updated

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, ForwardHealth does not automatically update the group affiliations of those individual providers.

Similarly, when an individual provider reports their group affiliations, ForwardHealth does not automatically update the group member information for those organizations or clinics.

Requirements for Specific Types of Group Affiliations

Providers are responsible for requirements that apply to them based on their type of group affiliation:

Requirements for Organizations and Clinics
How to Report Group Member Information During Initial Enrollment and Revalidation

During initial enrollment and revalidation on the ForwardHealth 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.

How to Report Changes in Group Member Information

Medicaid-enrolled organizations and clinics enter or update group member information using the demographic maintenance tool. Organizations and clinics are required to enter or update group member information any time a change occurs (for example, 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 (for example, address or payee information).

How to Report 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 NPI or Medicaid ID of each group member.

How to Report 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 (for example, a new provider joins or leaves the group). Failure to keep group information current may cause loss of your group enrollment.

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

How to Report Group Member Information 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.

How to Report Changes in Group Affiliations

Individual Medicaid-enrolled providers enter or update information about their group affiliations using the demographic maintenance tool. Providers are required to enter or update information about group affiliations anytime a change occurs (for example, the provider joins or leaves a new clinic). ForwardHealth strongly encourages individual Medicaid-enrolled providers 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 (for example, 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. Failure to keep group information current may cause providers to lose group enrollment. Entering new information on a claim form or prior authorization request is not adequate notification.

 
 
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