Behavioral Health Rehabilitative Treatment (Provider Type 82)
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 |
|---|---|---|
| 882 | Behavioral Health Rehabilitative Treatment Entity/Agency/Group | 06/24/2020 |
| 300 | Qualified Mental Health Professional (QMHP) | 07/28/2022 |
| 301 | Qualified Mental Health Associate (QMHA) | 02/26/2024 |
| 302 | Qualified Behavioral Aide (QBA) | 02/26/2024 |
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.