LOOKING FOR ASSISTANCE

The provider enrollment application for consultant agency is available for interested providers to download. Be sure that all paperwork in the application is filled out completely and accurately.  Include all requested documentation with the application to avoid delay or denial of your application.

For more information about the Mi Via Program, please review the Mi Via Program webpages including Service Standards and regulations NMAC 8.314.6 .

Application Documents

The documents below will assist you with the application process.

• Mi Via Self-Directed Waiver Consultant Application Packet
• Mi Via Self-Directed Waiver Consultant Provider Agreement
• Mi Via Waiver Self-Imposed Moratorium Form

Billing

Please see the  Mi Via Self-Directed Waiver Billing Instructions document for more information about billing.

To receive assistance with billing, please contact Conduent at their 1-800-299-7304 toll-free phone number.