Yes! You can use AI to fill out Form HFS 2243, Provider Enrollment Application Illinois Medical Assistance Program

medical forms: Form OWCP-915, Claim for Medical Reimbursement, Form 8994, Employer Credit for Paid Family and Medical Leave, Form OF-178, Certificate of Medical Examination, Form N-648, Medical Certification for Disability Exceptions, U.S. Coast Guard Form CG-719K, Application for Medical Certificate, The Department of Medical Assistance Services Applied Behavior Analysis Preservice Service Authorization Request Form (Effective Dates of Service 09/01/2025 and after), State of Illinois Department of Children and Family Services Medical Report on an Adult in a Child Care Facility (CFS 602), Carer Payment and Carer Allowance – Medical Report (SA431) for a child under 16 years, Medically Prescribed Treatment (Non-Medication) Form — Provider Treatment Order Form | Office of School Health | School Year 2025–2026, VA Form 10-7959f-2, Foreign Medical Program (FMP) Claim Cover Sheet, Department of Medical Assistance Services Applied Behavior Analysis (97155, Et al.) Initial Service Authorization Request Form, Applied Behavior Analysis Concurrent Service Authorization Request Form (CPT Codes 97153, 97154, 97155, 97156, 97157, 97158, 0373T) – Virginia Department of Medical Assistance Services, Department of Medical Assistance Services Enhanced Services Individual Service Plan (ISP) Template, Form DS-1843, Medical History and Examination for Individuals Age 12 and Older, Scheduled Medical Leave of Absence (MLOA) - BLET 13, Admissions Application, School of Diagnostic Imaging, Mills-Peninsula Medical Center, Albany Medical Center 2024 Benefits Guide, Form BWC-1141, Request for Medical Information, VA Form 21P-8416, Medical Expense Report, Medicare Enrollment Application for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Suppliers, CMS-855S

medical provider forms: Medically Prescribed Treatment (Non-Medication) Form — Provider Treatment Order Form | Office of School Health | School Year 2025–2026, California Participating Physician Application, Form WH-380-E, Certification of Health Care Provider

VA medical forms: Form OWCP-915, Claim for Medical Reimbursement, Form 8994, Employer Credit for Paid Family and Medical Leave, Form OF-178, Certificate of Medical Examination, Form N-648, Medical Certification for Disability Exceptions, U.S. Coast Guard Form CG-719K, Application for Medical Certificate, The Department of Medical Assistance Services Applied Behavior Analysis Preservice Service Authorization Request Form (Effective Dates of Service 09/01/2025 and after), State of Illinois Department of Children and Family Services Medical Report on an Adult in a Child Care Facility (CFS 602), Carer Payment and Carer Allowance – Medical Report (SA431) for a child under 16 years, Medically Prescribed Treatment (Non-Medication) Form — Provider Treatment Order Form | Office of School Health | School Year 2025–2026, VA Form 10-7959f-2, Foreign Medical Program (FMP) Claim Cover Sheet, Department of Medical Assistance Services Applied Behavior Analysis (97155, Et al.) Initial Service Authorization Request Form, Applied Behavior Analysis Concurrent Service Authorization Request Form (CPT Codes 97153, 97154, 97155, 97156, 97157, 97158, 0373T) – Virginia Department of Medical Assistance Services, Department of Medical Assistance Services Enhanced Services Individual Service Plan (ISP) Template, Form DS-1843, Medical History and Examination for Individuals Age 12 and Older, Scheduled Medical Leave of Absence (MLOA) - BLET 13, Admissions Application, School of Diagnostic Imaging, Mills-Peninsula Medical Center, Albany Medical Center 2024 Benefits Guide, Form BWC-1141, Request for Medical Information, VA Form 21P-8416, Medical Expense Report, Medicare Enrollment Application for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Suppliers, CMS-855S

Medi-Cal forms: Form OWCP-915, Claim for Medical Reimbursement, Form 8994, Employer Credit for Paid Family and Medical Leave, Form OF-178, Certificate of Medical Examination, Form N-648, Medical Certification for Disability Exceptions, U.S. Coast Guard Form CG-719K, Application for Medical Certificate, The Department of Medical Assistance Services Applied Behavior Analysis Preservice Service Authorization Request Form (Effective Dates of Service 09/01/2025 and after), State of Illinois Department of Children and Family Services Medical Report on an Adult in a Child Care Facility (CFS 602), Carer Payment and Carer Allowance – Medical Report (SA431) for a child under 16 years, Medically Prescribed Treatment (Non-Medication) Form — Provider Treatment Order Form | Office of School Health | School Year 2025–2026, VA Form 10-7959f-2, Foreign Medical Program (FMP) Claim Cover Sheet, ABA Authorization Request (Medi-Cal) – Initial and Concurrent Requests, Department of Medical Assistance Services Applied Behavior Analysis (97155, Et al.) Initial Service Authorization Request Form, Applied Behavior Analysis Concurrent Service Authorization Request Form (CPT Codes 97153, 97154, 97155, 97156, 97157, 97158, 0373T) – Virginia Department of Medical Assistance Services, Department of Medical Assistance Services Enhanced Services Individual Service Plan (ISP) Template, Form DS-1843, Medical History and Examination for Individuals Age 12 and Older, Scheduled Medical Leave of Absence (MLOA) - BLET 13, Admissions Application, School of Diagnostic Imaging, Mills-Peninsula Medical Center, Albany Medical Center 2024 Benefits Guide, Form BWC-1141, Request for Medical Information, VA Form 21P-8416, Medical Expense Report

enrollment forms: Form CMS-855O, Medicare Enrollment Application, Form CMS-4040, Request for Enrollment in Medicare Part B, Form CMS-40B, Application for Enrollment in Medicare Part B, Providence Health Plan Out-of-Area Dependent Enrollment Form, Empower Enrollment Form, Empower Enrollment Form, Principal Life Insurance Company UCTIE INTERNATIONAL UNION 401(K) SAVINGS PLAN Enrollment Form, Enrollment Application, Northwell Residents Open Enrollment Benefits Guide 2026, University of Colorado 403(b) Plan – DSW Scudder Enrollment and Beneficiary Designation Form, Merrill Funds Transfer Service Enrollment Form, Funds Transfer Service Enrollment Form, Standing Letter of Authorization / Instruction Enrollment Form, Merrill RMD Service Enrollment and Authorization Form, Fidelity Investments Account Application/Enrollment Form and Beneficiary Designation, MyMerrill® Client Order Entry Enrollment Form, CMS-855I, Medicare Enrollment Application for Physicians and Non-Physician Practitioners, Form CMS-855R, Medicare Enrollment Application - Reassignment of Medicare Benefits, CMS-855R, Medicare Enrollment Application: Reassignment of Medicare Benefits, CMS-855R, Medicare Enrollment Application: Reassignment of Medicare Benefits

medical assistance forms: Department of Medical Assistance Services Applied Behavior Analysis (97155, Et al.) Initial Service Authorization Request Form, The Department of Medical Assistance Services Applied Behavior Analysis Preservice Service Authorization Request Form (Effective Dates of Service 09/01/2025 and after), Applied Behavior Analysis Concurrent Service Authorization Request Form (CPT Codes 97153, 97154, 97155, 97156, 97157, 97158, 0373T) – Virginia Department of Medical Assistance Services, Department of Medical Assistance Services Enhanced Services Individual Service Plan (ISP) Template, Addendum for Maryland Medical Assistance Program Application School Based Health Center, Form SY061, Medical statement - Assistance for Isolated Children (AIC) Scheme

enrollment application forms: Form CMS-855O, Medicare Enrollment Application, Form CMS-40B, Application for Enrollment in Medicare Part B, Enrollment Application, Fidelity Investments Account Application/Enrollment Form and Beneficiary Designation, CMS-855I, Medicare Enrollment Application for Physicians and Non-Physician Practitioners, Form CMS-855R, Medicare Enrollment Application - Reassignment of Medicare Benefits, CMS-855R, Medicare Enrollment Application: Reassignment of Medicare Benefits, CMS-855R, Medicare Enrollment Application: Reassignment of Medicare Benefits, Medicare Enrollment Application for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Suppliers, CMS-855S, CMS-855B, Medicare Enrollment Application for Clinics/Group Practices and Other Suppliers, CMS-855A, Medicare Enrollment Application for Institutional Providers, Form CMS-855A, Medicare Enrollment Application for Institutional Providers, Medicare Enrollment Application - Medicare Diabetes Prevention Program (MDPP) Suppliers, Form CMS-20134, Provider Enrollment Agreement (OHA 3975), Oregon Medicaid ID Application Form, Medical Baseline Allowance Application (Used for Medical Baseline Enrollment and Re-Certification), Blue Cross and Blue Shield of Texas Group Enrollment Application/Change Form, Form CMS-40B, Application for Enrollment in Medicare Part B (Medical Insurance) (01/24), Form CMS-18-F-5, Application for Medicare Part A (Hospital Insurance)

provider enrollment forms: CMS-588 Electronic Funds Transfer (EFT) Authorization Agreement Checklist, CMS-855A, Medicare Enrollment Application for Institutional Providers, Form CMS-855A, Medicare Enrollment Application for Institutional Providers, Medicaid of Alaska Provider Electronic Remittance (835) Authorization and Claims Enrollment Form, Medicaid Alaska EDI Enrollment - Provider Information Submission Agreement, Arkansas Medicaid Provider Application Packet (DMS-652), Form CMS-855R, Medicare Enrollment Application - Reassignment of Medicare Benefits, Provider Enrollment Agreement (OHA 3975), Oregon Medicaid ID Application Form, Provider Group/Facility Application (RA-02), Indiana Health Coverage Programs (IHCP) Managed Care Entity (MCE) Provider Enrollment Form

medical enrollment forms: Medicare Enrollment Application for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Suppliers, CMS-855S, Medical Baseline Allowance Application (Used for Medical Baseline Enrollment and Re-Certification), Form CMS-40B, Request for Enrollment in Medicare Part B (Medical Insurance), Form CMS-40B, Application for Enrollment in Medicare Part B (Medical Insurance) (01/24), Form CMS-18-F-5, Application for Medicare Part A (Hospital Insurance), Form CMS-855O, Medicare Enrollment Application

HFS forms: Form HFS 3082, Drug Prior Authorization Request Form

EDI enrollment forms: Medicaid Alaska EDI Enrollment - Provider Information Submission Agreement, Form CMS-855O, Medicare Enrollment Application, Form CMS-4040, Request for Enrollment in Medicare Part B, Form CMS-40B, Application for Enrollment in Medicare Part B, CMS-855I, Medicare Enrollment Application for Physicians and Non-Physician Practitioners, Form CMS-855R, Medicare Enrollment Application - Reassignment of Medicare Benefits, CMS-855R, Medicare Enrollment Application: Reassignment of Medicare Benefits, CMS-855R, Medicare Enrollment Application: Reassignment of Medicare Benefits, Medicare Enrollment Application for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Suppliers, CMS-855S, CMS-855B, Medicare Enrollment Application for Clinics/Group Practices and Other Suppliers, CMS-855A, Medicare Enrollment Application for Institutional Providers, Form CMS-855A, Medicare Enrollment Application for Institutional Providers, Medicare Enrollment Application - Medicare Diabetes Prevention Program (MDPP) Suppliers, Form CMS-20134, Medicaid of Alaska Provider Electronic Remittance (835) Authorization and Claims Enrollment Form, Medicaid of Minnesota (Administered by HealthPartners of Minnesota) EDI Trading Partner Enrollment Form, Medical Baseline Allowance Application (Used for Medical Baseline Enrollment and Re-Certification), Form CMS-40B, Request for Enrollment in Medicare Part B (Medical Insurance), Form CMS-40B, Application for Enrollment in Medicare Part B (Medical Insurance) (01/24), Form CMS-18-F-5, Application for Medicare Part A (Hospital Insurance)