Facility/Agency/Organization/Institution
Use these steps to begin a new FAO enrollment application.
Prior to enrollment, providers must register with OWCP Connect before starting their online enrollment application.
- Select the Facility/Agency/Organization/Institution radio button.
- If you are already enrolled in the Medicaid Provider Enrollment, Chain, and Ownership System (PECOS) and want to populate enrollment data from PECOS, select the Yes radio button. If you want to manually enter the data, select the No radio button.
- Complete the Provider Type, NPI, and FEIN fields. If you selected Yes to populate data from PECOS, you must also select the Practice Location State and enter the Practice Location Zip.
- Select the Submit button.
- If there are any errors with the PECOS data, you will receive an error message that no matching provider information was found. Select Cancel to verify the details or Continue to manually enter the provider's information.
- If no errors are found, the System displays the Basic Information page.
- Select a Provider Type.
- Select a Program.
- Enter the required (*) information based on your previous selections.
- Select the Finish button.
The System displays the Basic Information page.
Important Note: The System displays a message providing the application number. Make note of this number since you will need it to track the enrollment application. Applications not submitted within 90 calendar days will be deleted.
- Select the OK button.
The System displays the Enroll Provider - Facility/Agency/Organization/Institution page.