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Provider Enrollment

Provider Enrollment Phone Numbers:
(888) 223-3630 (Nationwide Toll-Free)
(334) 215-0111

Hours: (all times Central)
Monday-Friday 8 a.m. to 5 p.m.

Supervisor: Jeff Kochik - (334) 215-4152 - Click to send e-mail

  • Forms for Provider Enrollment and Re-Enrollment
  • Electronic Provider Enrollment Application Portal
  • Provider Enrollment Web Portal Training Manual
  • Providers Required to Submit an Enrollment Fee
  • Rural Health Clinic Cost Report - Useful information to help new providers establish the rate for reimbursement

    ACA Primary Care Physician Attestation:
    Attention: Qualifying providers whose board certification expires on December 31, 2013.

    REMINDER: You must reattest and submit board certification proof (web verification printout is preferred) to continue receiving the ACA Primary Care Rate increase, AKA “BUMP” payment. 

    To reattest, the physician must complete the Alabama Medicaid Certification and Attestation for Primary Care Rate Increase Form, attach board certification proof, and return it to the address specified on the form.

    As stated on the Alabama Medicaid Certification and Attestation for Primary Care Rate Increase Form, Note: Qualification for the payment increase will end the earliest of either 12/31/2014 or the expiration date of the board certification. Therefore, physicians whose board certifications expire during the calendar year 2013 or 2014, must reattest for the program; services provided during any lapses in time between board certification expiration and reattestament will not be eligible for the rate increase. The physician must notify HPES within 10 days if the board certification is lost.”

    Effective Date for Rate Increase.  Qualifying physicians who submitted their self-attestation to HPES will be paid the enhanced reimbursement effective for dates of service beginning with the date the attestation is entered into the system by HPES.

    A major provision of the Affordable Care Act (ACA) requires Alabama Medicaid reimburse certain primary care physicians at parity with Medicare for services provided between January 1, 2013 and December 31, 2014.  The physician must complete the Alabama Medicaid Certification and Attestation for Primary Care Rate Increase Form, and return it to the address specified on the form.  The rate increase will become effective for dates of service beginning with the date the attestation is entered into the system by HPES.  Medicaid will not grant retroactive payment for providers who fail to attest at the time of enrollment or fail to reattest timely.

    Under the federal regulations, the physicians qualify for the rate increase if:
    1) They have a specialty or subspecialty designation in family medicine, general internal medicine, or pediatrics that is recognized by the American Board of Medical Specialties (ABMS), the American Board of Physician Specialties (ABPS), or the American Osteopathic Association (AOA) and they actually practice in these areas.

    2) They are not board certified but are practicing in the fields of family medicine, general internal medicine, or pediatrics or a subspecialty under one of these specialties, and 60% of their Medicaid procedures billed are for evaluation and management codes 99201 through 99499 and VFC services. NOTE: The 60% threshold is based on the number of paid billed services as identified by individual billing codes for E&M services for the primary specialty, plus vaccine administration services, and the denominator equals the total number of paid billed codes. Therefore, paid billed codes for ancillary services such as lab, x-rays, injections will cause the percentage threshold to be less.

    3) They complete a self-attestation form to meeting the requirements above.

    Re-Enrollment:
    Federal requirements mandate providers re-enroll periodically with the Alabama Medicaid program. Providers will be notified when they are scheduled to re-enroll.  Failure to re-enroll and provide appropriate documentation to complete enrollment will result in an end-date being placed on the provider file. Once a provider file has been closed for failure to timely re-enroll, providers will have to submit a new application for enrollment.

    The listing of providers selected to re-enroll for the current month is listed under
    Re-Enrollment Forms entitled
    "List of Providers Scheduled to Re-Enroll."

    Ordering, Prescribing and Referring Providers:
    Federal law requires all physicians and other practitioners who prescribe or order services for Medicaid recipients, or who refer Medicaid recipients to other providers, must be enrolled as a Medicaid provider. Claims will deny beginning January 1, 2013, if provider is not enrolled.