Provider Enrollment and Forms

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.

To download and print the ACHN Alabama Medicaid Primary Care Physician Group Enrollment Agreement, click here.

Provider Enrollment Contact Information:
Enrolling as a Medicaid Provider
Fingerprint-Based Criminal Background Check Information
Revalidation

Federal requirements mandate providers revalidate periodically with the Alabama Medicaid program. Providers will be notified when they are scheduled for revalidation. Failure to revalidate 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 revalidate, providers will have to submit a new application for enrollment.