Provider Enrollment on the Portal Instructions
Page Filters
These pages will guide you through each stage of the enrollment process using PEP. To customize this page's content, use the filters below and click the Apply Filters button.

Application Type:

Program(s):

Enrolling As:

Are you a School Health and Related Services (SHARS) Provider?

Are you a Hospital Provider?

Provider Type Specific

Instructions for Completing the Provider Type Specific page.

  • Select Private or Public for “Are you a private or public entity?”
  • Public entities are owned or operated by city, state, county, or government agencies and instrumentalities. Public entities include agencies that perform intergovernmental transfers to the state or that certify and provide state-matching funds.
  • If you are a public entity that is required to certify expended funds, all of the fields must be completed.
  • Section: Facilities Only
  • If you are enrolling as a facility, you must answer all of the Facilities Only questions.
  • This section will only appear if you checked facility as your applicant type on the Provider Type Identification Form.
  • Select “Yes” or “No” for “Is this a freestanding facility?” or “Is this a hospital-based facility?”
  • You cannot answer “No” to both questions.
  • Select “Yes” or “No” for “Is this an ESRD facility?”
    • Enter your composite rate in the field for “What is your composite rate?”
  • Section: Public/ Non-Public Providers (Required by all providers)
  • If you are enrolling as a Public Provider, you must answer all of the Public/ Non-Public Providers (Required by all providers) questions.
  • This section will only appear if you are enrolling as a state-owned (public) provider
  • Enter an answer into the field for “Do you have children's unit(s)?”
  • Click Continue and Save.
 
Contents
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