016.06.13 Ark. Code R. 005
Any provider of health care services must be enrolled in the Arkansas Medicaid Program before Medicaid will cover any services provided by the provider to Arkansas Medicaid beneficiaries. Enrollment as a Medicaid provider is contingent upon the provider satisfying all rules and requirements for provider participation as specified in the applicable provider manual, state and federal law. Persons and entities that are excluded or debarred under any state or federal law, regulation or rule are not eligible to enroll, or to remain enrolled, as Medicaid providers.
All providers must sign all applicable forms that require a signature and the Arkansas Medicaid Provider Contract. The signature must be an original signature or an approved electronic signature of the individual provider. The provider's authorized representative may sign the contract for a group practice, hospital, agency or other institution.
In addition to the information in Section 140.000, Section II of each program's provider manual may contain supplemental provider type specific participation requirements. The provider enrollment functions for the Arkansas Medicaid Program are performed by an independent contractor. The contractor is responsible for provider enrollment services for new providers and changes to current provider enrollment files. Potential providers must complete all appropriate portions of a provider enrollment Application Packet to execute the provider contract. They must also submit a copy of all certifications and licenses verifying compliance with enrollment criteria for the applicable provider type or discipline to be practiced and pay the application fee (if applicable). See Section 141.101 for Application Fees.
Potential providers may enroll on the Arkansas Medicaid website at
https://www.medicaid.state.ar.us.Potential providers that are not required to pay application fees may also send the printed form to the Medicaid Provider Enrollment Unit. View or print the Provider Enrollment contact information.
All subsequent state license and certification renewals must be forwarded to the Medicaid Provider Enrollment Unit within 30 days of issuance. If the renewal document(s) have not been received within this timeframe, the provider will have an additional and FINAL 30 days to comply. Failure to timely submit verification of license or certification renewals will result in cancellation of enrollment in the Arkansas Medicaid Program. View or print the provider enrollment and contract package (Application Packet).
In addition to the submission of the Application Packet, the following forms are required and must be submitted to complete the enrollment process:
Each provider must notify the Medicaid Provider Enrollment Unit in writing immediately regarding any changes to its application or contract status, such as:
When the provider has successfully met all requirements, the Medicaid Provider Enrollment Unit will assign a unique Medicaid number to the provider. The assigned provider number is linked to the provider's tax identification number (either a Social Security Number or a Federal Employer Identification Number) and to the provider's National Provider Identifier (NPI) unless the provider is an atypical provider not required to have an NPI.
Federal regulation 42 CFR 455.414 requires Arkansas Medicaid to revalidate the enrollment of all providers regardless of provider type, at least every 5 years. Revalidation of an enrollment includes:
The revalidation notice will be sent to the provider 90 days before their revalidation deadline using the "Mail To" address on file. It is important that providers keep their address information up to date to ensure that they receive this notice. Failure to submit the required documentation prior to the deadline will interrupt the ability to have claims paid.
Providers enrolling on or after July 1, 2013 will have a future revalidation date set at the time of their enrollment. All providers that were enrolled before July 1, 2013 will be required to revalidate their enrollments upon receipt of notice from Medicaid Provider Enrollment. This initial revalidation will determine the revalidation cycle for providers.
Federal regulation 42 CFR 455.460 requires that Arkansas Medicaid collect applicable application fees from prospective or re-enrolling providers prior to the execution of the Medicaid Provider Contract and issuance of a Medicaid Provider ID number.
The following providers are not required to pay the application fee to Arkansas Medicaid:
The application fee will be subject to change each year in accordance with the federally published application fee.
All providers that are required to pay an application fee must enroll online. Application fees must be paid by credit card, debit card or electronic funds transfer and submitted with the online application.
Applications submitted without payment, proof of payment or exception letter will not be accepted. (See Section 141.102 for Hardship Exceptions requirements.) Providers must maintain their supporting documentation on file.
Section 1866 (j)(2)(C)(iii) of the Act permits the Secretary of the federal Department of Health and Human Services to grant, on a case-by-case basis, exceptions to the application fee for institutional providers and suppliers enrolled in the Medicare and Medicaid programs and CHIP, if the Secretary determines that imposition of the fee would result in a hardship. Such requests will be considered on a case-by-case basis, as required by the statute.
Federal regulation 42 CFR 455.450 requires that Arkansas Medicaid screen all initial applications, including applications for a new practice location, and any applications received in response to a re-enrollment or revalidation of enrollment based on a categorical risk assessment; and conduct on-site visits in accordance with 42 CFR 455.432, which includes pre-enrollment and post enrollment site visits as well as unannounced on-site inspections of any provider location.
016.06.13 Ark. Code R. 005