Start an application
We encourage providers to enroll in the Medicaid program. We offer providers two
ways to complete an application.
Applying online is easy and saves you time. You will be guided through a series
of steps that should take no longer than one hour to complete, however. If you are
short on time, you may start an application, save it after completing only the first
step, and then return to continue the application at a more convenient time.
To start an online application click Start.
NOTICE: Use of this application is restricted
to authorized users. User activity is monitored and recorded by system personnel.
Anyone using this application expressly consents to such monitoring and recording.
BE ADVISED: if possible criminal activity is detected, system records, along with
certain personal information, may be provided to law enforcement officials.
print an application, complete it and mail it to us. This document opens
with Mirosoft Word (.doc). When you click the link, the document opens in a new
window. To return to this page, close the window. If you click the link and the
document doesn't open,
download Microsoft Word Viewer free so you can view and print the document.
Mail applications to:
HP Enterprise Services
Attn: Provider Enrollment
P.O. Box 8105
Little Rock, AR 72203-8105