Department of Health. Division of Medicaid and Health Financing. Bureau of Authorization and Community Based Services

This is the application, medicaid agreement, and other documentation submitted by health care providers to enroll in the medicaid program. This record series is divided into the following categories: pharmacies, medical transportation, optometrist, laboratories, dentists, audio-speech therapists, optical supplies, osteopaths, physical therapists, in-state and out-state hospitals, medical supplies, dialysist, birthing rooms, clinics, physicians, nursing homes, rural health, home health, and public health. The file includes institutional and non-institutional medicaid provider applications, medicaid provider agreements, signature cards, medical licenses, copies of medicare certification, notifications of change, the name andaddress of the health care provider, the application date, the provider's license number and date of license, the type of provider, the medicare number, the employer identification number or social security number, the categories or service offered, the number of certified beds, the name and address of clinic affiliation, the type of practice organization, the provider identification number,and the names of individuals authorized to sign medicaid claims. At the beginning of 1989 these records are recorded on optical disk. Records prior to this time will be microfilmed and kept in the office for reference.

This is the application, medicaid agreement, and other documentation submitted by health care providers to enroll in the medicaid program. This record series is divided into the following categories: pharmacies, medical transportation, optometrist, laboratories, dentists, audio-speech therapists, optical supplies, osteopaths, physical therapists, in-state and out-state hospitals, medical supplies, dialysist, birthing rooms, clinics, physicians, nursing homes, rural health, home health, and public health. The file includes institutional and non-institutional medicaid provider applications, medicaid provider agreements, signature cards, medical licenses, copies of medicare certification, notifications of change, the name and address of the health care provider, the application date, the provider's license number and date of license, the type of provider, the medicare number, the employer identification number or social security number, the categories or service offered, the number of certified beds, the name and address of clinic affiliation, the type of practice organization, the provider identification number,and the names of individuals authorized to sign medicaid claims. At the beginning of 1989 these records are recorded on optical disk. Records prior to this time will be microfilmed and kept in the office for reference.