How to become a Medicaid provider in Vermont
To bill Vermont Medicaid, enroll through Provider Management Module (PMM), run by Gainwell Technologies. The process has 6 steps, listed below with the documents the state asks for.
- Enrollment portal
- Provider Management Module (PMM)
- Steps
- 6
- Documents
- 6
- Plans listed
- —
On this page
Vermont Medicaid enrollment at a glance
To bill Vermont Medicaid, enroll through Provider Management Module (PMM), run by Gainwell Technologies. The process has 6 steps, listed below with the documents the state asks for.
- Program
- Vermont Medicaid / Green Mountain Care (Department of Vermont Health Access, DVHA)
- Enrollment portal
- Provider Management Module (PMM)
- Fiscal agent
- Gainwell Technologies (enrollment department and revalidation notices)
- Application fee
- Under 42 CFR 455.460, institutional and certain other providers pay the application fee on initial enrollment, new practice locations and revalidation. Proof of payment goes to DVHA with the application. The fee is waived if already paid to Medicare, another state's Medicaid program or another Vermont state agency. CMS decides hardship waivers, and DVHA passes on the result. Under the federal rule (42 CFR 455.460), institutional providers pay the CMS application fee when they first enroll, re-enroll or revalidate. The fee is $750 for calendar year 2026. Individual physicians and non-physician practitioners do not pay it. A fee already paid to Medicare or to another state's Medicaid program counts.
- Fingerprinting
- High-risk providers get a fingerprint-based criminal background check. DVHA follows the CMS risk categories, under which newly enrolling DMEPOS suppliers and newly enrolling home health agencies are high risk. DVHA may raise a provider's risk level at any time, for example after a payment suspension, exclusion or Medicare revocation.
- Site visit
- Moderate-risk providers get on-site visits, for example ambulance suppliers, community mental health centers, CORFs, hospices, independent clinical labs, IDTFs and physical therapists. High-risk providers get them too.
- Revalidation
- Providers get system notices 90 and 45 days before their contract end date, and screening is repeated at revalidation. Missing the deadline ends enrollment, and coming back requires a new application. Under its 2026 strategy, Vermont is revalidating high-risk providers off-cycle starting July 1, 2026 and selected moderate-risk providers starting January 1, 2027 (about 300 providers); Gainwell contacts those affected. Federal rule (42 CFR 455.414) requires the state to revalidate every enrolled provider at least once every 5 years.
- Provider manual
- Provider manual
Steps
- Get an NPI and read the PMM Provider Enrollment Instructions Manual
- Launch the Provider Management Module and fill out the online application (paper forms are no longer required)
- Complete the Vermont Medicaid Disclosure Form and the provider agreement
- Upload supporting documentation, including license details and proof of any application fee paid
- Complete risk-based screening (site visit or fingerprints if applicable)
- Ordering, prescribing and referring (OPRA) providers who will not bill can use the shorter OPRA application
Documents the state asks for
Joining managed-care plan networks
- Credentialing
- DVHA's provider pages list no private Medicaid managed care plans. Providers join the Green Mountain Care network directly through the Gainwell-run enrollment process. No separate plan credentialing or centralized MCO credentialing is described.
Frequently asked questions
How do I become a Medicaid provider in Vermont?
To bill Vermont Medicaid, enroll through Provider Management Module (PMM), run by Gainwell Technologies. The process has 6 steps, listed below with the documents the state asks for.
Is there an application fee to enroll in Vermont Medicaid?
Under 42 CFR 455.460, institutional and certain other providers pay the application fee on initial enrollment, new practice locations and revalidation. Proof of payment goes to DVHA with the application. The fee is waived if already paid to Medicare, another state's Medicaid program or another Vermont state agency. CMS decides hardship waivers, and DVHA passes on the result. Under the federal rule (42 CFR 455.460), institutional providers pay the CMS application fee when they first enroll, re-enroll or revalidate. The fee is $750 for calendar year 2026. Individual physicians and non-physician practitioners do not pay it. A fee already paid to Medicare or to another state's Medicaid program counts.
How often must Vermont Medicaid providers revalidate?
Providers get system notices 90 and 45 days before their contract end date, and screening is repeated at revalidation. Missing the deadline ends enrollment, and coming back requires a new application. Under its 2026 strategy, Vermont is revalidating high-risk providers off-cycle starting July 1, 2026 and selected moderate-risk providers starting January 1, 2027 (about 300 providers); Gainwell contacts those affected. Federal rule (42 CFR 455.414) requires the state to revalidate every enrolled provider at least once every 5 years.