AxisCare Medicaid Billing New State Form

Please fill out this form if you are interested in signing up for AxisCare Medicaid Billing when your state becomes available.

Are you currently an AxisCare customer?*

First Name*

Last Name*

Email*

State*

AxisCare Site Number*

How many Medicaid clients do you serve?*

Please provide your best estimate.

If you are contracted with any MCOs, which ones?

If you are enrolled in any waiver programs with your state, which ones?

Which aggregator(s) do you currently utilize for EVV?

Examples: HHAeXchange, Sandata, Tellus, LASRS, etc.