Resources: Provider Enrollment Policy Manual, Screening Glossary, and Trainings
Provider Enrollment Policy Manual
The Provider Enrollment Policy Manual contains all policy related to provider enrollment with AHCCCS.
Provider Enrollment Screening Glossary
The Provider Enrollment Screening Glossary is a tool to help determine the following screening requirements:
- Provider type to services rendered,
- Enrollment Type (Page 4) AHCCCS Provider Enrollment form: Sections I-A & I-B,
- NPI requirement,
- Fee requirement,
- Site Visit requirement,
- Fingerprint-Based Criminal Background requirement,
- Risk Category
When reviewing the Provider Enrollment Screening Glossary (PEP-903), it’s important to select the correct enrollment type at the initial enrollment submission. Outlined below are definitions of the available enrollment types listed within the glossary.
- Individual – Regular Individual/Sole Proprietor or Rendering/Service Provider,
- Group Biller - This enrollment type acts as a “Group Biller Only” provider type 01 (an organization electing to act as a financial representative for any provider or group of providers),
- Individual (Driver, Home Help/Personal Care, Carpenter, etc.),
- Agency (Child Care Institution, Home Help/Personal Care Agency, Transportation Company, etc.)
These instructional, step-by-step documents are designed to teach providers how to enroll within the AHCCCS Provider Enrollment Portal (APEP).
Use the Provider Enrollment Screening Glossary (PEP-903) to determine which enrollment type is the correct reference document for you.
For additional information about provider types please email APEPTrainingQuestions@azahcccs.gov.
AHCCCS has built a specialized population groups code set to allow for identification of providers that can treat various populations. The creation of the specialized population group identification will be reported in the application submitted in the AHCCCS Provider Enrollment Portal (APEP). Its data will be used for the purpose of identifying providers with specific specialized population groups. Benefits for this identification include opportunities for improved network analysis and eventually a resource for families and members.
This instructional, step-by-step tutorial is designed to show the provider how to report the population group sets in APEP.
Category of service is the description of the types of services rendered at a provider type level. Each provider type has certain categories of service available. Some are mandatory and others are optional. Mandatory categories of service are automatically assigned at a provider level and require licensure or certification. Optional categories of service can be added at a provider level based on their enrolled provider type and may require licensure or certification. Optional categories can be added by submitting a ticket.
The document titled Add a New Category of Service (PEP-906) lists the possible licenses and certifications that may be required for each category of service. Follow the instructions in the document to submit a ticket to add a new category of service.
Providers may reference the Change of Ownership Flow chart or Follow the steps below to request a CHOW:
- Report the change to ADHS - The organization will need to have an active license to enroll with AHCCCS.
- Report the CHOW to AHCCCS as soon as you are aware of the change but no later than 35 days after the CHOW. This can be done one of the following ways:
- The old owner discloses the change in APEP On the Modification Request Checklist, answers "yes" to the question "Do you wish to end date your enrollment?” and provides a date and the details that there has been a CHOW.
- The CHOW is reported by sending an email to apeptrainingquestions@azahcccs.gov informing AHCCCS that there has been a CHOW. If the new owners intend to use the same NPI, the existing profile will need to be terminated before the new enrollment can be started. The provider may use the same NPI or acquire a new one, but they will need to make sure the details in NPPES are current with the new ownership.
- New ownership completes and submits a new enrollment application
- Screening activities are conducted based on the risk level assigned to the provider type of the organization under the new ownership.
- A decision is made on the new enrollment application.
NOTE: In the situation of a CHOW, AHCCCS MAY consider a retroactive enrollment start date to prevent gaps in enrollment between the old ownership and the new.
Features of the PEPM
How to Establish a New User Single Sign-on
New Enrollment
Online Training Sessions
AHCCCS providers can schedule online training sessions with the Provider Enrollment team to learn how to use the AHCCCS Provider Enrollment Portal (APEP). The sessions are conducted over Zoom with a shared screen so you can see how to navigate the APEP system.
If your organization would like to request additional training on how to enroll in APEP, modify your provider ID, or navigate APEP, schedule a training session. Please send your request for specific training, and your organization’s name and contact information, to APEPTrainingQuestions@azahcccs.gov.
