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Expressive Therapy Provider Medicaid Enrollment Guide

This guide is only providers of expressive therapies, including music, art, equine and pet therapy. Providers who wish to continue offering these services to members must contract directly with Sunshine Health.

Before You Begin

Keep this information on hand before starting the process:

  • Name, date of birth, Social Security Number and home address of each person with ownership or a controlling interest in the provider.
  • Name, Federal Employer Identification Number (FEIN) and applicable addresses for each entity with ownership or a controlling interest in the provider.
  • Internal Revenue Service (IRS) document showing the provider's name and Taxpayer Identification Number (TIN).
  • Professional or facility license number, as appropriate.
  • National Provider Identifier (NPI) from the National Plan and Provider Enumeration System (NPPES), as appropriate.
  • Documentation of any adverse actions involving:
    • Criminal history
    • Disciplinary action against any license
    • Denial, termination, exclusion, suspended payments, or unpaid fines from Medicare or Medicaid in Florida or any state

Medicaid Enrollment Process

Step 1: Visit the Enrollment Application. Read the Welcome Statement and select New Application.

Step 2: Enrollment Type Determination

You will be presented with four options.

  • Select the first option: To participate in the network of a Medicaid health plan
  • The next screen explains this is known as Limited Enrollment, making it easier to register with Florida Medicaid
  • Select Continue to view Application Tips, a checklist of documents and information you should have on hand before continuing
  • Select Continue

Step 3: Request Type

Here’s how to answer the following questions:

  • Is the provider enrolled with Medicare: No
  • Is this application based on a change of ownership (CHOW): No
  • Application Type: Facility or Other Business Entity
  • Provider Type: 97-Manaced Care Treating Provider – Non-Medicaid
  • Primary Specialty: 987 – SMMC Atypical
  • Primary Taxonomy: 171W00000X/Contractor
  • Select Save & Continue

Sept 4: Enrollment Application

This screen lists the information you should have on hand before proceeding to the next steps, including a National Provider Identifier (NPI) and Taxpayer Identification Number (TIN). Individual applicants can use their Social Security Number (SSN) as their TIN.

  • Select Save & Continue

Step 5: Identifying Information

Enter the following information.

  • Tax ID Type (Select SSN if you use your Social Security Number as your TIN)
  • Name of Business
  • Doing Business as (D/B/A), if applicable
  • Ownership Code
  • Practice Type Code
  • Select Save & Continue

Step 6: License & More Identifying Information

Enter the following information

  • License Number
  • License State
  • DEA (Drug Enforcement Agency) Number, if applicable
  • CLIA (Clinical Laboratory Improvement Amendments) Number, if applicable

Step 7: Contact Information

Enter your contact information, including your primary phone number (numbers only) and email address.

Step 8: Service Location

Enter the physical address of the location where services will be rendered, including a primary phone number and email address for the site.

Step 9: Mailing Address

Enter your mailing address (you have the option of using the physical address from Step 8)

Step 10: Home/Corp Office Address

Enter the address of your home or corporation (you have the option of using the physical or mailing address from the previous steps)

Sept 11: Application Saved/ATN Issued

You have entered enough information so that your application will be automatically saved.

  • Your application will be assigned an Application Tracking Number (ATN)
  • Save the ATN and Name of Business for future use, such as working with Sunshine Health, checking on the status of your application with the state, etc.

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