The Submit screen is where applicants read the Medicaid Rules, Regulations, Policy and 42USC 1320a-7b Agreement. The Agreement is displayed in a scrolling window. Scroll down to view the entire document

• Once the Terms of Agreement have been reviewed, click the I Agree checkbox to agree to the terms and conditions

• If left unchecked, the application cannot be submitted for approval

• The date and time is entered for you

Required Fields:

• Please note that all fields marked with an asterisk (*) are required fields that must be populated in order to move forward. If they are left blank you will receive an error message

Special Characters:

• The following Special Characters cannot be used in the situations below. Field properties will not allow the following characters in the box:

 For First Name, Business Name, Other name (if any):    | + \ '

 For Last Name field:    | + \ ', and numbers are not allowed

 For Comment Boxes:     <  >  ^  ~ ` + | \ / ¬ £

 For Address fields:    | + ! @ # $ ^ * ( ) ? / \ " < > & : ; _

• If you copy and paste an excluded special character, an error message will display after clicking Save & Next

• Remove excluded characters from pasted information or uploaded text in the document

Save & Next:

• When finished, click Save & Next to save the information and proceed to the next page

• Click Back to go to the previous screen without saving

• Click Exit to return to the dashboard without saving

• Note that if the information is not saved, you will lose the data on the current page