Provider portal
Enrolled providers manage enrollment, revalidation and eligibility checks in the provider portal. Sign in to the provider portal
Medicaid provider enrollment
Health care providers who serve Franklin Medicaid members must enroll with the state, including providers who only see members through a managed care plan. Enrollment confirms your license, ownership and practice locations and screens against federal and state exclusion lists.
Before you apply
- A National Provider Identifier (NPI) for the individual or organization
- Current professional license and any board certifications
- Ownership and managing employee information
- Practice locations, taxonomy codes and banking details
Applications are screened by risk level. Moderate and high risk provider types may receive a site visit, and high risk types require fingerprint background checks.
Revalidation
Every enrolled provider must revalidate at least once every five years. We send a reminder notice before your revalidation date. If you don't revalidate in time, your enrollment ends and claims will deny.
Managed care
Most Medicaid members receive care through managed care health plans that contract with the department. Plans are responsible for their own provider networks, prior authorization and claims payment.
- Plan contracts and oversight. The department sets contract standards, network adequacy rules and quality measures for every plan.
- Encounter data. Plans submit encounter records for every service paid. The department publishes the encounter data specifications and companion guides for plan and vendor use.
- Plan report cards. Annual report cards compare plans on access, quality and member experience.
Reportable conditions
State rules require physicians, laboratories, hospitals and other facilities to report certain communicable diseases and conditions to the local health department. Some must be reported immediately by phone, others within 24 hours, and others within 7 days.
| Timeframe | Examples |
|---|---|
| Immediately | Suspected outbreaks, measles, botulism, any unusual cluster of illness |
| Within 24 hours | Pertussis, hepatitis A, foodborne illness, Shiga toxin-producing E. coli |
| Within 7 days | Chronic hepatitis B and C, Lyme disease, tuberculosis infection |
Facilities that send data electronically connect to the state's disease surveillance and immunization registries through an onboarding process.
Professional licensing
The Franklin Board of Nursing licenses registered nurses, licensed practical nurses and advanced practice registered nurses in the state. You can verify a nursing license, apply for a license by examination or endorsement, and renew online.
Policies and billing
Clinical coverage policies, fee schedules and billing guides for fee-for-service Medicaid are updated through monthly provider bulletins. Read the bulletin each month for changes that affect your practice.