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IBM WebSphere Portal
Dec 18, 2017
Quick Links   Skip portlet
Provider Enrollment   Skip portlet
To enroll as a Medicaid provider you need to login to the secured provider portal.

If already a registered provider, please login below.

If you are not a registered provider, please click the "Web Registration" link below to register.


User ID     
Password     


If you are a first time user, by registering you will be designated as the Primary Account Holder for your organization.  As the designated Primary Account Holder, you can add, delete or modify user access.

If you are a user supporting an organization associated with a provider who is registering in order to submit a Medicaid enrollment application, then as a new Primary Account Holder registratant, you need only complete the following step:

  1. Establish a User Id, password and security profile


After the enrollment application is approved, you must then complete the remaining registration steps noted below:

  1. Request secured access for your organization
  2. Successfully complete a one-time verification process of 3 questions
  3. Upon receipt of confirmation email, click link within email
  4. Sign in to the secured portal


If you are not the Primary Account Holder for your organization, then you should not register. If your organization already has a Primary Account Holder, please see them for your User Id and Password to log in.

Please click here for Web Registration


To access paper enrollment forms for completion and manual submission, please click here