ATTENTION: In preparation for the June 29, 2020 update to the Provider Enrollment component of PRISM, the system will be unavailable between May 14 and June 28, 2020. Medicaid is unable to accept any new provider enrollment applications or modifications during this period. Starting June 29, providers will be able to enter new enrollment applications and submit modifications to PRISM online.

Once we go live, if a retroactive enrollment date is needed due to the freeze, please upload a retroactive enrollment request along with your application or modification.  The Provider Enrollment Team will approve those requests back to May 14, 2020.

If you have questions, please contact the Provider Enrollment Team at 1-800-662-9651, option 3, then option 4.

To review frequently asked questions click here.

Provider enrollment forms will not be available until June 29, 2020.