Thank you for your interest in becoming a provider with AHCCCS. On this page you will find information about how to apply to become an AHCCCS registered provider as well as what to expect after you become an approved provider.
In general, the process to become an AHCCCS registered provider and maintain your enrollment is as follows:
Preparing for the Provider Application
To prepare for the AHCCCS Provider Enrollment application, have the following documentation available when you apply:
National Provider Identifier (NPI) – The federal government requires that providers who administer “medical and other health services” should obtain an NPI number – a unique 10-digit identification number for covered health care providers. For more information visit the National Plan and Provider Enumeration System (NPPES) webpage at https://nppes.cms.hhs.gov or contact the NPI Enumerator at 1-800-465-3203 or TTY 1-800-692-2326.
Completed W9 Tax Form - Request for Taxpayer Identification Number and Certification – Any provider who will be receiving state/federal funds for services rendered or provided to Medicaid recipients must provide completed W9 tax form as part of the application process. The W9 form can be found on the IRS website.
Current Professional Certifications or Licensures – Providers must maintain current and ongoing certification or licensure when enrolling and participating in the Medicaid Program with an active status of the provider enrollment AHCCCS ID.
If enrolling as a behavioral health provider, Arizona Department of Health Services will issue a Certificate & Transmittal (C&T) upon request along with the state license. The C&T is required for behavioral health providers issued a license in Arizona, as it identifies the provider type the applicant should enroll under. The Behavioral Health Provider Types pdf identifies which provider types require the C&T. For additional questions about the C&T, visit Arizona Department of Health Services or contact the Office of Medical Facilities at 602-364-3030.
If enrolling as one of the following provider types listed below, the additional documentation is required as part of the enrollment process. Review the instructions section outlined in each form, download the form, complete, and upload it in the AHCCCS Provider Enrollment Portal (APEP) under the Upload Document step as “Document Type-License” under “Document Name-AHCCCS Provider Registration.”
Any other supporting documentation associated with your provider type. Review the Enrollment Screening glossary to help determine the screening requirements for your provider type.
If you are unable to use APEP to submit your application, the AHCCCS Provider Enrollment Application form may be used. The form will only be accepted if the provider has extenuating circumstances that explain why they cannot use the AHCCCS Provider Enrollment Portal System (APEP). Circumstances must be outlined in a written statement along with submission of the AHCCCS Provider Enrollment Application form.
General AHCCCS Provider Enrollment Requirements
Each applying provider must be screened based on their assigned risk level. The general screening requirements for each risk level are outlined below.
Limited
Moderate
High
Verify that a provider meets any applicable Federal regulations or State requirements for the provider type prior to making an enrollment determination,
License verifications,
Conduct Database Checks.
Verify that a provider meets any applicable Federal regulations or State requirements for the provider type prior to making an enrollment determination,
License verifications,
Conduct Database Checks,
Site Visit.
Verify that a provider meets any applicable Federal regulations or State requirements for the provider type prior to making an enrollment determination,
Section 6401(a) of the Affordable Care Act (ACA) requires the State Medicaid Agency to impose a fee on each “institutional provider of medical or other items, services, and suppliers.” The application enrollment fee amount is the same fee that applies to Medicare enrollment. The enrollment fee does not include non-institutional providers (e.g., Practitioners, Dentist, Group Billers). The purpose of the enrollment fee collected by the State Medicaid Agency is to offset the cost of conducting the required screening for the provider application. The enrollment fee is collected during the new enrollment, revalidation, and reactivation of a disenrolled provider.
The fee amount increases each calendar year and is issued by the Centers for Medicare and Medicaid Services (CMS). The enrollment fee for calendar year 2023 is $688, effective January 1, 2023 through December 31, 2023.
Processing Timeframes And Enrollment Effective Dates
Processing Timeframes
AHCCCS generally processes Provider Enrollment applications within 60 days of submission. An expedited application process may be requested. Some examples of what may justify an expedite includes (but is not limited to):
An emergent Medical need of an AHCCCS member such as a transplant or and out-of-state emergency service,
An AHCCCS member needs placement or relocation,
The provider is a Department of Child Safety Foster Parent.
Follow the steps below to request an expedited application:
Complete a Provider Enrollment Application in the AHCCCS Provider Enrollment Portal (APEP).
Email your request to expedite. The following information is required and must be included in the email:
Provider Name,
Provider National Provider Identification Number (NPI),
Provider Taxpayer Identification Number (TIN),
Application number located in APEP,
The reason for the expedited request.
Any requests missing the required information will not be processed. The email request should be sent to APEPTrainingQuestions@azahcccs.gov Once your email has been submitted, you will receive a ticket number confirmation. It’s important that you do not resubmit an email for the same reason, as this will impact the timeliness of your request
Provide any additional information or supporting documentation that may be needed to complete the expedite request.
Complete all required screening and enrollment steps required for AHCCCS Provider Enrollment process.
Enrollment Effective Dates
In general, the effective date of AHCCCS enrollment is the date the application is approved. A retroactive enrollment date may be requested. Some examples of what may justify a retroactive enrollment includes (but is not limited to):
An emergent Medical need of an AHCCCS member such as a transplant or an out-of-state emergency service,
A change in provider type, licensure, ownership or service location which required a new application in APEP,
A physician began providing Medicaid covered services at the request of a Managed Care Organization,
The provider was previously terminated for failure to complete revalidation.
This list is not all available reasons why a retroactive enrollment date may be considered. These are examples and not a guarantee of a retroactive enrollment. All requests are reviewed on a case-by-case basis.
Follow the steps below to request a retroactive enrollment date:
Complete a Provider Enrollment Application in the AHCCCS Provider Enrollment Portal (APEP)
Complete all required screening and enrollment steps required for AHCCCS Provider Enrollment process.
Send an email to APEPTrainingQuestions@azahcccs.gov. The following information must be included in the email:
Provider Name
Provider National Provider Identification Number (NPI)
Provider Taxpayer Identification Number (TIN)
Application number located in APEP
The reason for the retroactive enrollment request.
Provide any additional information or supporting documentation that may be needed to complete the retroactive enrollment request.
Maintaining Enrollment as an AHCCCS Provider
Reporting Changes and Maintaining Current License and Certifications
After being approved as an AHCCCS registered provider, you are required to:
Report any changes to your information using APEP. Changes may include, but are not limited to:
Change in service address,
Changes in ownership or managing employees,
get more from PE.
Maintain current license and certifications,
Respond to any requests from AHCCCS about your enrollment information.
Revalidation
A provider must revalidate their enrollment every four years to maintain Medicaid billing privileges. AHCCCS reserves the right to request off-cycle revalidations.
During the revalidation process the provider is subject to the same screening and disclosures captured during the initial enrollment. Based on provider type the screening requirements could include an enrollment fee, site visit, and fingerprint criminal background check.
Revalidate 10 Month Plan is a list of providers that must complete a revalidation within the next 10 months.
