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The Combined Application to Become a Medicaid/DDD Approved Provider is open for all services that are currently anticipated to be available in the Medicaid-based, fee-for-service system, through both the Supports Program and the Community Care Waiver.

How Do I Become a Medicaid/DDD Approved Service Provider?

Step 1:
The first step in becoming an approved provider of Division-funded services in the fee-for-service system is to apply for a Medicaid National Provider Identifier (NPI) at the National Plan and Provider Enumeration System (NPPES) web page. (An agency will typically have just one NPI, regardless of the number of services offered or service locations available).

Step 2:
Once the NPI is received, the agency or individual provider must complete the Combined Application to Become a Medicaid/DDD Approved Provider. The Division's pre-recorded webinar, Becoming an Approved Provider, provides an overview of the Combined Application process.

The Combined Application serves two purposes:

(1) Applying to become an approved Medicaid provider, -AND-
(2) Applying to become an approved Division of Developmental Disabilities (DDD) provider for the specific services the agency or individual plans to provide (whether through the Supports Program, the Community Care Waiver, or both)

Please note:
• The Combined Application must be downloaded, printed and mailed via regular postal mail.
• Agencies are strongly advised to retain a copy of their original Combined Application.
• If a provider agency wishes to add services at a later date, the Combined Application must be submitted again for the new services.

Additional Steps for Agencies Interested in Providing Support Coordination Services

Support Coordination is a Medicaid-only service that cannot be provided through the Fiscal Intermediary.

Prior to submitting the Combined Application, agencies interested in providing Division-funded Support Coordination services must:

(1) Review the Division's revised Conflict-Free Policy
(2) Review the Support Coordinator's Guide to Unusual Incident Reporting
(3) Submit an Agency Letter of Interest and an Agency Conflict-Free Policy (both on agency letterhead ) to the Supports Program Helpdesk at: 


Agencies approved to provide Support Coordination services can request access to the iRecord.

For the initial request for iRecord access, the Support Coordination Supervisor must complete the iRecord Request Form, scan it, and send it via email to A username and temporary password will be sent to the Support Coordination Supervisor, including instructions on re-setting the initial temporary password.

After the initial account is set up, the Support Coordination Supervisor can log into the iRecord and request additional users.

Change your iRecord password
Additional Steps for Agencies Interested in Providing Day Habilitation Services

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