Provider Application Process

01. Application. Providers who meet Medicaid enrollment requirements may apply for provider status with the Department. All providers eligible for an NPI must apply with that number. For providers not eligible for an NPI, the Department will assign a provider number upon approval of the application. (7-1-26) 02. Disclosure of Information. All enrolling providers and any additional disclosable party must comply with the disclosure requirements in 42 CFR Part 455, Subpart B, “Disclosure of Information by Providers and Fiscal Agents.” (7-1-26) 03. Denial of Provider Agreement. The Department may refuse a request to enter into a provider agreement, extend an existing agreement, or enter into additional agreements with any provider. Requests for a provider agreement are denied when: (7-1-26) a. The provider fails to meet the qualifications required by rule or by any applicable licensing board. (7-1-26) b. The provider was a managing employee, or had an ownership interest, in any entity and: (7-1-26) i. Previously found by the Department to have engaged in fraudulent or abusive conduct related to the Medicaid program; or (7-1-26) ii. Demonstrated an inability to comply with the requirements related to the provider status for which application is made, including submitting false claims or violating provisions of any provider agreement; (7-1-26) c. Failed to repay the Department for any overpayments or improper claims, whether the failure resulted from refusal, bankruptcy, or otherwise, unless prohibited by law. (7-1-26) d. The provider employs as a managing employee, contracts for any management services, shares any ownership interests, or would be considered a related party to any individual or entity identified in this section. (7-1-26) IDAHO ADMINISTRATIVE CODE IDAPA 16.03.26 Department of Health & Welfare Medicaid Plan Benefits Section 022 Page 23 e. The provider is currently suspended or terminated from Medicare or Medicaid in any state. (7-1-26)