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    Provider Enrollment Resources

    Published 06/17/2022

    WTC Health Program Administrative Manual

    WTC Health Program FAQs for Existing Providers

    WTC Health Program Terms and Conditions (PDF)

    Request for Taxpayer Identification Number and Certification (Form W-9) (PDF)

    Electronic Funds Transfer (EFT) Authorization Agreement (Form CMS-588) (PDF)

    WTC Health Program Quick Reference Provider Guide (PDF)

    Have Questions?

    Contact the WTC Health Program Call Center: 888-982-4748

    Email WTCHP Provider Enrollment

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