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Provider enrollment information

Provider Enrollment Information

Page Contents

New Enrollment Application Fee Requirements
Frequently Asked Questions Regarding Practitioner Identification Numbers (PIN)
Online Provider Enrollment Application
Access to the Provider Information Portal
Change Your Demographic Information Online
Printable Enrollment-Related Forms
Enrollment FAQ

New Enrollment Application Fee Requirements

Effective July 1, 2013, the Arkansas Medicaid Program adopted new enrollment application fee requirements that have been mandated as part of the Affordable Care Act (ACA). The changes include:

  • All providers regardless of provider type are required to re-enroll every five (5) years.

  • Certain provider types are subject to an application fee. The Centers for Medicare & Medicaid Services (CMS) sets the application fee amount, which may vary or be adjusted from year to year and is payable every five (5) years. This federally mandated fee will be used to offset the cost of conducting new screening activities associated with the ACA. View the list of providers required to pay the fee. (PDF, new window)

    These providers must enroll online and pay an application fee.

  • If the provider is enrolled in Medicare and has paid the application fee to Medicare, or if the provider is enrolled in another state’s Medicaid Program and has paid the application fee to that state’s Medicaid Agency, the provider is not required to pay the application fee to Arkansas Medicaid.

  • Individual providers (such as physicians, dentists, therapists) and groups of individual providers (such as physician groups, dental groups, therapy groups) are not required to pay the application fee.

The complete rule is available for viewing in Section 140.000 – Section I All Provider Manuals. (Word, new window)

The new enrollment process is set to begin April 1, 2014. Providers will receive a ninety (90) day notice that they must comply with the new enrollment guidelines. Providers will also receive notices sixty (60) and thirty (30) days prior to their enrollment deadline.

Frequently Asked Questions Regarding Practitioner Identification Numbers (PIN)

Frequently asked questions regarding Practitioner Identification Numbers (PIN) has been added to the website. View PIN frequently asked questions.

Online Provider Enrollment Application

A Web-based provider enrollment application has been added to the Arkansas Medicaid website. You can find a link to the online application by selecting "Provider information," then selecting “Start an application” in the "Enrollment" section of the navigation bar on the left of your screen. View the online provider enrollment application.

Access to the Provider Information Portal

Only currently active providers have access to the provider information portal. Inactive or suspended providers must contact the Provider Enrollment Unit before they will be able to log on the portal.

There is only one password per provider number. This information should be given to individuals who need access to the provider information portal for checking eligibility or submitting claims. Providers are encouraged to designate one primary account holder to maintain their provider portal account. Security question answers should only be given to the primary account holder in the event that they need access to change or reset security credentials. The current password and security question answer are required to change or update an account's security credentials.

HIPAA requirements mandate the following security measures for the provider information portal:

  • Users will be automatically directed to change their password if it matches their Tax ID/SSN or Medicaid/BreastCare provider ID.
  • Passwords must meet all of the password requirements for the provider portal.
  • Users must select a security question and provide an answer to that question to be used later to unlock the account or recover a password.
  • Security question answers must:
    • Be at least 4 characters long
    • NOT contain the user ID
    • NOT contain the security question
  • Users will be redirected to the log-on page if there is no activity on a secure page for more than 20 minutes.
  • Users will be locked out of an account automatically after six failed log in attempts within an hour. To unlock an account, users should follow the Provider Portal Password Self-Help Guidelines. (PDF, new window)
  • Users can change a Provider Portal password through the “My Information” menu.

For assistance with your Provider Portal password, view the Provider Portal Password Self-Help Guidelines. (PDF, new window)

Change Your Demographic Information Online

Non-facility providers can change their demographic information online after they have logged on the provider information portal. Previously, all demographic changes required contacting Provider Enrollment.

Printable Enrollment-Related Forms

Address Change Form
Change of Ownership Form
Contract to Participate in Arkansas Medicaid
Data Sharing Agreement 
Electronic Fund Transfer (EFT) Authorization for Automatic Deposit 
EPSDT Agreement
Disclosure of Significant Business Transactions
Media Selection/e-Mail Address Change Form
Medicaid Primary Care Physician (PCP) Certification and Attestation Form
NPI Reporting Form
Office of Long Term Care Contract
Ownership and Conviction Disclosure
PCP Agreement
Practitioner Identification Number Request Form
Provider Enrollment Application and Contract Packet
Section IV - Group Affiliation
WebRA Hardship Waiver Application 

Provider Enrollment Staff

Enrollment FAQ

How can I become an Arkansas Medicaid provider?

How can I apply for a temporary Arkansas Medicaid provider number?

How long does it take for my enrollment application to process?

What are some tips for helping my provider application or re-enrollment progress more smoothly?

How can I change my PCP caseload?

How can I change my demographic information?

Why can't I access the provider information portal?

What are the requirements for passwords on the provider information portal?

How can I be certain to receive my applicable manual updates, official notices, and RA messages by e-mail?

Where can I get more information about Practitioner Identification Numbers (PIN)?

What electronic and digital signatures will Arkansas Medicaid accept?

How can I become an Arkansas Medicaid provider?

To enroll as an Arkansas Medicaid provider, you will need to submit an application and contract. To access the online application, select "Start an application" from the "Enrollment" section in the navigation bar on the left of your screen. You can also apply by filling out a paper application. Section V of each provider manual includes a link to the Arkansas Medicaid Provider Application and Contract - Form DMS-652. View or print an application and contract.

If you have questions about how to enroll, call Arkansas Medicaid Provider Enrollment at (501) 376-2211 (local or out of state) or (800) 457-4454 (Arkansas). When prompted, select 0 for "Other Inquiries", then option 3 for "Provider Enrollment". View or print Provider Enrollment contact information.

The links above open Microsoft Word documents (.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.

If you are required to have a National Provider Identifier (NPI), you must report it to Arkansas Medicaid once enrolled as an Arkansas Medicaid provider. For more information about the NPI, view NPI frequently asked questions.

How can I apply for a temporary Arkansas Medicaid provider number?

Arkansas Medicaid does not issue temporary provider numbers. To obtain an Arkansas Medicaid provider ID number, you must complete an application for enrollment. See How can I become an Arkansas Medicaid provider?

How long does it take for my enrollment application to process?

The application process can take 30 business days. Delays with your application can occur if it contains incomplete or incorrect items. When applying online, there is less possibility for making errors that would result in your application being denied and returned to you for correction. If you fail to enter needed information, you will be prompted to provide the missing information.

The Provider Enrollment Unit will return incomplete and incorrect applications by mail with a denial letter. You should complete or correct the application as instructed in the denial letter and return the entire application to the Provider Enrollment Unit.

What are some tips for helping my provider application or re-enrollment progress more smoothly?

Our enrollment specialists have listed some tips to help your application or re-enrollment progress more smoothly.

  1. Some parts of the enrollment application must be mailed or delivered to Provider Enrollment. No faxes or photocopies will be accepted for these items. Original signatures are required on these documents:
  • W-9 forms
  • Contract
  • Section IV-group affiliation
  • Electronic Fund Transfer (EFT) Authorization for Automatic Deposit 
  • Name change forms
  • Change of ownership forms (if applicable)
  • Address change forms
  • PCP agreement (if applicable)
  • EPSDT agreement (if applicable)
  1. You must submit credentials annually. A good rule of thumb is to fax a current copy to Provider Enrollment when you mail your license/certification renewal fees to your state. When faxing state licenses, please make certain you fax the current license. Always check the expiration date before faxing.
  2. When submitting credentials for re-enrollment, always write your provider number on the form. This will help us process your renewal more quickly if there are several providers under the same tax ID number.
  3. When enrolling for Electronic Fund Transfer (EFT) Authorization for Automatic Deposit, you must attach a voided check or a letter from the bank. Deposit slips are not accepted to set up EFTs.
  4. If you have been inactive with Arkansas Medicaid for 6 months, you must submit a new application.
  5. W-9 forms and contracts for individual providers must be submitted in their name, with their Social Security number, and their original signature. If the W-9 or contract is for a group or facility, it must include the tax ID number and an original signature. A tax coupon is also acceptable in place of a W-9 form.

How can I change my PCP caseload?

Providers can now change their patient caseloads online at the Arkansas Medicaid website utilizing the Provider Information Portal. To set the PCP caseload over 2500, Provider Enrollment requires a written request stating why the higher caseload is needed. The request should be mailed to:

Medicaid Provider Enrollment Unit
HP Enterprise Services
P.O. Box 8105
Little Rock, AR 72203-8105

No faxes or photocopies will be accepted. An original signature is required on the request. If the PCP caseload is set over 2500 using the online form, an error will be reported and no change will be made.

How can I change my demographic information?

Non-facility providers can change their demographic information online after they have logged onto the provider information portal.

Why can't I access the provider information portal?

Only currently active providers have access to the provider information portal. Inactive or suspended providers must contact the Provider Enrollment Unit before they will be able to log on the portal.

There is only one password per provider number. This information should be given to individuals who need access to the provider information portal for checking eligibility or submitting claims. Providers are encouraged to designate one primary account holder to maintain their provider portal account. Security question answers should only be given to the primary account holder in the event that they need access to change or reset security credentials. The current password and security question answer are required to change or update an account's security credentials.

HIPAA requirements mandate the following security measures for the provider information portal:

  • Users will be automatically directed to change their password if it matches their Tax ID/SSN or Medicaid/BreastCare provider ID.
  • Passwords must meet all of the password requirements for the provider portal.
  • Users must select a security question and provide an answer to that question to be used later to unlock the account or recover a password.
  • Security question answers must:
    • Be at least 4 characters long
    • NOT contain the user ID
    • NOT contain the security question
  • Users will be redirected to the log-on page if there is no activity on a secure page for more than 20 minutes.
  • Users will be locked out of an account automatically after six failed log in attempts within an hour. To unlock an account, users should follow the Provider Portal Password Self-Help Guidelines. (PDF, new window)
  • Users can change a Provider Portal password through the “My Information” menu.

For assistance with your Provider Portal password, view the Provider Portal Password Self-Help Guidelines. (PDF, new window)

What are the requirements for passwords on the provider information portal?

Passwords for the Provider Portal must adhere to specific requirements. All passwords are case sensitive and must:

  • Be between 8 and 20 characters in length
  • Contain at least 1 alpha character
  • Contain at least 1 numeric character
  • Contain at least 1 uppercase character
  • Contain at least 1 lowercase character
  • Contain at least 1 special character
  • NOT contain the same character more than twice
  • NOT contain the user ID
  • NOT be any of the previous 6 passwords

How can I be certain to receive my applicable manual updates, official notices, and RA messages by e-mail?

To be certain you receive your updates by e-mail:

  1. Ensure that you have chosen e-mail notification as your preferred media selection. This instructs us to send you applicable manual updates, official notices, and RA messages by e-mail instead of mailing you paper copies of these documents.

You can change your media selection by completing the Media Selection/E-mail Address Change Form. Return the form by mail to HP Enterprise Services-Technical Publications with an original signature.

  1. Be sure we have your current e-mail address on file.

We recommend a general e-mail account accessible by all billing staff to ensure that each provider stays up-to-date on Medicaid policies. For example, HealthCareBillers@healthcare.com instead of Suzy@healthcare.com.

Check with your Web provider or information technology department to set up a general e-mail account and then notify HP Enterprise Services of your new e-mail address using one of two forms. You can use the Media Selection/E-mail Address Change Form. Return the form by mail to HP Enterprise Services-Technical Publications with an original signature. Alternatively, you can use the Address Change Form to notify Provider Enrollment. This form requires an original signature for processing as well.

  1. Make sure your e-mail address will accept e-mail from hp.com

If you have not received e-mail from ARKCDTeam@hp.com in the past three months, your e-mail address may not currently accept mail from hp.com. Instruct your network administrator or e-mail provider to accept e-mails from “hp.com” Arkansas Medicaid sends e-mail in bulk, and some e-mail services may block bulk e-mail unless instructed otherwise.

Where can I get more information about Practitioner Identification Numbers (PIN)?

Frequently asked questions regarding Practitioner Identification Numbers (PIN) has been added to the website. View PIN frequently asked questions.

What electronic and digital signatures will Arkansas Medicaid accept?

The approved electronic and digital methods are indicated below.

  • ePadlink electronic signature pad
  • Topaz Systems, Inc. electronic signature pad
  • any digital signature currently issued by the Arkansas State Certificate Authority (provided by DHS)
  • any digital signature verifiable against a current certificate authority accepted by the Microsoft Windows certificate program (http://support.microsoft.com/kb/931125).