Enrollee Transfer Request

For enrollee use only. Providers are prohibited from submitting enrollee transfer requests.
All transfer requests will take effect the 1st of the following month. Please allow up to 48 hours for transfers to be completed. For immediate transfers, please contact our Member Service Dept at 833-276-0850 for assistance.

Step 1: Search for Provider Office

Select Benefit Plan

Benefit Plan

Enter Location

Step 2: Select Provider Office to be Assigned

Dentist NameOffice LocationMore InfoSelect

Step 3: Enter Member Details

OFFICE DETAILS


MEMBER DETAILS

Yes

By clicking “Submit”, I affirm that I am a Florida Medicaid enrollee. I acknowledge that use of this form by anyone other than the enrollee named above is considered potentially fraudulent and may be subject to corrective action by the Plan.

Please only click Submit once