Medicare/caid Enrollment Preference Form

Medicare / Medicaid Enrollment Preference Form

Complete this form if you would like to enroll with Medicare or Medicaid plans
Please note: Grow does not currently allow providers to bill directly with Medicare or Medicaid. Instead, we work with Managed Care plans, which require separate enrollment processes from the state. If you choose to enroll with and see Medicare or Medicaid clients below, we will automatically enroll you with the Managed Care plans available in your licensed state(s).
Email*
Please enter the email on file with Grow Therapy
Would you like to enroll with and see Medicaid clients?*

YesNo
Would you like to enroll with and see Medicare clients?*

YesNo
Should be Empty:

Medicare / Medicaid Enrollment Preference Form