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 |
|---|---|---|
| 181 | Federally Qualified Health Center (FQHC) | 07/08/25 |
| 188 | Certified Community Behavioral Health Center (CCBHC) | 07/08/25 |
Return to Enrollment Checklists page.
If you have any questions, please contact the Gainwell Technologies Contact Center at (877) 638-3472 from 8:00AM to 5:00PM, Monday through Friday.