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Enrollment

Start an application

We encourage providers to enroll in the Medicaid program. We offer providers two ways to complete an application.

Online

Apply online 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.

Paper

Download MS Word Viewer You may 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