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A provider must complete and pass all screening requirements to be enrolled, including compliance and agreement to a Provider Participation Agreement. Once a provider’s application is approved, they will receive a welcome notice.
Approval Letters
Approval letters shall include the following information:
The provider name;
The National Provider ID associated with the approval;
The effective date of approval; and
A name and phone number for an AHCCCS contact.
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Term |
Definition |
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Provider Participation Agreement |
An agreement between AHCCCS and the provider or group biller to govern the registration of, and payment to, the provider or group biller on behalf of the affiliated provider for services provided to persons who have been determined eligible for health care coverage through AHCCCS. |
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Affiliated provider |
A provider of health care or medical services who has entered into a separate provider participation agreement with AHCCCS and has authorized the group biller to act as its financial representative. |
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Group biller |
An organization acting as the financial representative of any affiliated provider or group of affiliated providers who have authorized the organization to act on the provider’s behalf. |
Enrollment is effective on the date the application is approved. In some instances, a provider may request a retroactive effective date. All requests are reviewed on a case-by-case basis. Some examples of what may justify a retroactive enrollment include:
An emergent medical need of an AHCCCS member such as a transplant or an out-of-state emergency service.
A change in provider type, licensure, ownership, or service location which required a new application in the AHCCCS Provider Enrollment Portal (APEP).
A physician begins providing Medicaid covered services at the request of a Managed Care Organization.
The provider was previously terminated for failure to complete revalidation.
These are not the only reasons a retroactive effective date may be considered. There is no guarantee that a retroactive enrollment will be approved.
For more information on requesting a retroactive effective date, go to the AHCCCS Provider Enrollment Portal (APEP) and see Processing Timeframes and Enrollment Effective Dates.
NOTE Non-Emergency Medical Transportation (NEMT) providers will not be granted a retroactive effective date.
All requested proof must be submitted with the completed application and provider participation agreement prior to approval.
Before requesting a retroactive enrollment date, there must be a completed Provider Enrollment Application in APEP and all required screening and enrollment steps for the AHCCCS Provider Enrollment process must be completed. All proof for a retroactive enrollment date request must be submitted with the request. Failure to submit supporting documentation with the request will result in the request being denied.
42 USC 1396a(a)(27)
42 CFR 431.107
42 CFR 431.108
42 CFR 455.410