Provider Enrollment – Part 2

Thank you for your submission. Your enrollment cannot be processed until these steps below are completed and the forms emailed to Grady’s credentialling team.

Providers Information

  1. All providers must have a permanent professional license.
  2. All providers must have a National Provider Identifier (NPI) in order to bill for services.
    If a NPI is needed, please apply at https://nppes.cms.hhs.gov/#/
  3. DEA certification is required only if a provider will be prescribing medications.

Provider Enrollment Requirements

Please complete three (3) very important steps for successful enrollments with payer plans:

  1. Medicaid POA form – Please sign, scan and return the attached Medicaid POA form via email (Grady Medicaid POA form) at your earliest convenience. Please provide your signature only, and the form will be completed and notarized as a professional courtesy to you by our Managed Care staff. Please sign your name as it appears on your medical license on the Signature of Provider line. Include your middle name (if used on your medical license). Please send signed form in pdf format as an attachment (not a picture).
  2. CAQH log in information – Please send your CAQH username and password. Please complete the following sections: Personal Information, Professional IDs, Education (including undergrad), Specialties, Employment, and Disclosure. We will need to add Grady-specific data for commercial plan enrollment, so please remember to send your CAQH username and password. https://proview.caqh.org/Login/Index?ReturnUrl=%2f
  3. CMS Surrogacy Approval – You will receive a CMS I&A Connection Request in your email very soon. Please approve access to PECOS, so that I can complete your Medicare enrollment. There is information attached (CMS Surrogacy Connection Approval Process) on how to approve a surrogacy request. Also, once your Medicare application is completed, you will be notified when you need to log back in to sign your Medicare application. https://nppes.cms.hhs.gov/IAWeb/warning.do

The signed Medicaid POA form and all requested information must be completed and emailed to [email protected] within the next 7 days. Please call the following personnel with questions:

Questions, please call:
Ochina Harris – Medicaid/CMS/Medicare, General questions (404) 616-2219
Freda “Artina” Thomas – CAQH (404) 616-0087

For problems with usernames, passwords, or website issues:
CAQH: 888-599-1771 (Mon-Fri 7 AM – 9 PM)
CMS External Users: 866-484-8049 (Mon-Fri 8 AM – 6 PM)

Back to Top