Provider Enrollment Portal Quick Guide: Change of Ownership Enrollment Application

A change of ownership resulting in a change of Federal Employer Identification Number (EIN) terminates the Provider Participation Agreement. The new owners and providers must re-apply with the new EIN, submitting a new enrollment application through the Provider Enrollment Portal that includes the selling provider's information and a new Provider Participation Agreement.

New owners/providers indicate that an enrollment application is connected to a change of ownership resulting in an EIN change on the Change of Ownership panel.

  1. Log in to the Provider Enrollment Portal.

    Acknowledge the Welcome panel by clicking Continue. Complete the Request Information panel and click Continue. The user will be navigated to the Change of Ownership panel.

  2. Change of Ownership Panel.

    The Change of Ownership panel initially displays with the field "Is the application due to a change of ownership where the EIN is changing?" set to "No".

    change of ownership panel default display

    Update the answer to "Yes". This action displays the Previous Ownership section. Complete all fields under the Previous Ownership section with the selling provider's information.

    change of ownership with updates

  3. Complete the remainder of your updates.

    Upon receipt of a completed change of ownership enrollment application, the selling provider will receive a letter from Health First Colorado (Colorado's Medicaid program) with further instruction on the voluntary disenrollment process.

    The change of ownership enrollment application cannot be processed for approval until the selling provider completes and submits a voluntary disenrollment request through the Provider Web Portal.

    Refer to the Disenrollment Provider Web Portal Quick Guide for more information on the disenrollment process.

    Visit the Change of Ownership FAQ web page for more information on change of ownership.


Need More Help?

Visit the Provider Enrollment web page for more resources on enrollment.