Specialties for Special Clinics (Provider Type 17)
To see which documents must be submitted with your Provider Enrollment Packet, click the name of your provider specialty in the list below. Out of state providers must also submit proof of Medicaid eligibility in the state that services are/were rendered.
| Specialty | Description | Updated Date |
|---|---|---|
| 166 | Family Planning | 09/04/19 |
| 167 | Genetics | 09/04/19 |
| 169 | Freestanding Birthing Centers | 09/08/21 |
| 174 | Public Health Clinic | 07/10/24 |
| 179 | School Based Health Centers (SBHC) | 09/04/19 |
| 180 | Rural Health Clinic | 06/20/23 |
| 181 | Federally Qualified Health Center | 06/20/23 |
| 182 | Indian Health Services, Non-Tribal | 06/16/22 |
| 183 | Comprehensive Outpatient Rehabilitation Facility | 06/20/23 |
| 188 | Certified Community Behavioral Health Center (CCBHC) | Certified Community Behavioral Health Center (CCBHC) Enrollment Criteria | 05/02/24 |
| 195 | Community Health Clinic, State Health Division | 07/10/19 |
| 196 | Special Children’s Clinic | 09/04/19 |
| 197 | TB Clinic | 09/04/19 |
| 198 | HIV | 09/04/19 |
Return to Provider Enrollment Checklists page.
If you have any questions, please contact the Provider Enrollment Unit at (877) 638-3472 from 8:00AM to 5:00PM, Monday through Friday.