Add Ownership Details
Use this link to add ownership details for the enrolling Provider. This information can be different from the Provider name and information, and the System uses it to capture the responsible person for this enrollment.
Note: You must complete all previous steps before you can complete the following procedure
To add ownership details:
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Select the Step 4: Add Ownership Details hyperlink.
The System displays the Add Ownership page.
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Select a Disclosure Type.
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Enter the required information depending on the Disclosure Type you selected.
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Select the Address button.
The System displays the Address details page.
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Enter the appropriate address in the Address Line 1 field.
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Enter the appropriate Zip Code.
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Select the Validate Address button.
The System auto-populates the remaining fields with the appropriate information.
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Confirm that the auto-populated information is correct and select the OK button.
The System saves the Address Details and displays the Add Ownership page.
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Select the OK button.
The System saves the Ownership Details and displays the Ownership List page.
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Select the Close button.
The System displays the Enroll Provider -Group Practice page.