Enrollee Transfer Request

For enrollee use only. Providers are prohibited from submitting member transfer requests.
Please allow up to 48 hours for transfers to be completed.

Step 1: Search for Provider Office

Search Criteria

Step 2: Select Provider Office to be Assigned

Dentist NameOffice LocationMore InfoSelect

Step 3: Enter Member Details




Success Error

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