Provider Enrollment Phone Numbers:
(888) 223-3630 (Nationwide Toll-Free)
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
Electronic Provider Enrollment Application Portal
Provider Enrollment Web Portal Training Manual
Providers Required to Submit an Enrollment Fee
NEW! Fingerprint-Based Criminal Background Check Information
Rural Health Clinic Cost Report - Useful
information to help new providers establish the rate for
Care Enhanced Physician Rates (“Bump”)
for dates of service October 1, 2016, Medicaid will resume
enhanced payments through the Alabama Medicaid Physician's
Primary Care Enhanced Rates "Bump" Program.
to fill out a self-attestation form. All fields on the
self-attestation form must be completed correctly. For
questions about how to fill out the form, please contact an
HPE Provider Representative at this link:
NOTE: In order to expedite the review
process, please make sure to include a
contact name and telephone number
along with the original self-attestation form to:
HPES, P.O. Box 241685, Montgomery, Alabama 36124.
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.
"List of Providers Scheduled to Re-Enroll."
The listing of providers selected to re-enroll for the current month
is listed under
Re-Enrollment Forms entitled
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.