Help Desks / Support Centers

(800) 457-4454
in-state toll-free or
(501) 376-2211
local and out-of-state

Arkansas Payment Improvement Initiative
(866) 322-4696 in-state toll-free or
(501) 301-8311 local and out-of-state

Magellan Medicaid Administration Pharmacy Help Desk
(800) 424-7895, Option 2 for Prescribers

Provider Enrollment Information

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Application Information

Instructions for how to complete your application (PDF, new window)

Video instruction for how to complete your application (MP4, new window)

Documents required for your application (PDF, new window)

Start your application now (HTML, new window)

Provider Enrollment Staff

FAQ

How can I become an Arkansas Medicaid provider?

Who must pay an application fee?

How can I apply for a temporary Arkansas Medicaid provider number?

How often must I re-enroll?

What are some tips for helping my provider application or re-enrollment progress more smoothly?

How can I change my PCP caseload?

How can I change my demographic information?

Why can’t I access the HealthCare Provider Portal?

What are the requirements for passwords on the HealthCare Provider Portal?

Where can I get more information about Practitioner Identification Numbers (PIN)?

What electronic and digital signatures will Arkansas Medicaid accept?

How can I become an Arkansas Medicaid provider?

To enroll as an Arkansas Medicaid provider, go the the online enrollment application. (HTML, new window) When applying online, there is less possibility for making errors that would result in your application being denied and returned to you for correction. If you fail to enter needed information, you will be prompted to provide the missing information.

If you have questions about how to enroll, call Arkansas Medicaid Provider Enrollment at (501) 376-2211 (local or out of state) or (800) 457-4454 (Arkansas). When prompted, select 0 for “Other Inquiries”, then option 3 for “Provider Enrollment”. View or print Provider Enrollment contact information. (Word, new window)

If you are required to have a National Provider Identifier (NPI), you must report it to Arkansas Medicaid once enrolled as an Arkansas Medicaid provider. For more information about the NPI, view NPI frequently asked questions.

Who must pay an application fee?

Certain provider types are subject to an application fee set by the Centers for Medicare & Medicaid Services (CMS). The fee may be adjusted from year to year and is payable every five (5) years. This federally mandated fee is used to offset the cost of conducting screening activities associated with the ACA.

View the list of providers required to pay the fee.

  • If the provider is enrolled in Medicare and has paid the application fee to Medicare, or if the provider is enrolled in another state’s Medicaid Program and has paid the application fee to that state’s Medicaid Agency, the provider is not required to pay the application fee to Arkansas Medicaid.
  • Individual providers (such as physicians, dentists, therapists) and groups of individual providers (such as physician groups, dental groups, and therapy groups) are not required to pay the application fee.

How can I apply for a temporary Arkansas Medicaid provider number?

Arkansas Medicaid does not issue temporary provider numbers. To obtain an Arkansas Medicaid provider ID number, you must complete an application for enrollment. See How can I become an Arkansas Medicaid provider?

How often must I re-enroll?

All providers are required to re-enroll every five (5) years regardless of provider type.

What are some tips for helping my provider application or re-enrollment progress more smoothly?

Our enrollment specialists have listed some tips to help your application or re-enrollment progress more smoothly.

  1. Apply online. Use the assigned tracking number to check your application’s status. You can also renew and revalidate your enrollment online using Resume Enrollment.
  2. You must submit credentials annually. A good rule of thumb is to Resume Enrollment on the HealthCare Provider Portal when you mail your license/certification renewal fees to your state. Please make certain you attach the current license. Always check the expiration date before attaching.
  3. When submitting credentials for re-enrollment, always add your provider number. This will help us process your renewal more quickly if there are several providers under the same tax ID number.
  4. When enrolling for Electronic Fund Transfer (EFT) Authorization for Automatic Deposit, you must attach a voided check or a signed letter from the bank. Deposit slips are not accepted to set up EFTs.
  5. If you have been inactive with Arkansas Medicaid for 6 months, you must submit a new application.
  6. W-9 forms and contracts for individual providers must be submitted in their name, with their Social Security number, and their original signature. If the W-9 or contract is for a group or facility, it must include the tax ID number and an original signature.

How can I change my PCP caseload?

Providers can change their patient caseloads on the HealthCare Provider Portal. If the PCP caseload is set over 2500 using the online form, an error will be reported and no change will be made. If you would like to set the PCP caseload over 2500, Provider Enrollment requires a written request stating why the higher caseload is needed. The request should be attached online.

How can I change my demographic information?

Demographic information can be viewed after you have logged onto the HealthCare Provider Portal under Characteristics. You must call enrollment to update this information, however. This is a security feature for your protection.

Why can’t I access the HealthCare Provider Portal?

Only currently active providers have access to the HealthCare Provider Portal. Inactive or suspended providers must contact the Provider Enrollment Unit before they will be able to log on the portal.

Both providers and trading partners are required to register on the HealthCare Provider Portal. It is possible that you must register as both a provider AND a Trading Partner.

HIPAA requirements mandate the following security measures for the HealthCare Provider Portal:

  • Users will be automatically directed to change their password if it matches their Tax ID/SSN or Medicaid/BreastCare provider ID.
  • Passwords must meet all of the password requirements for the HealthCare Provider Portal.
  • Users must select a security question and provide an answer to that question to be used later to unlock the account or recover a password.
  • Security question answers must:
  • Be at least 4 characters long
  • NOT contain the user ID
  • NOT contain the security question
  • Users will be redirected to the log-on page if there is no activity on a secure page for more than 20 minutes.
  • Users will be locked out of an account automatically after six failed log in attempts within an hour.

What are the requirements for passwords on the HealthCare Provider Portal?

Passwords for the HealthCare Provider Portal must adhere to specific requirements. All passwords are case sensitive and must:

  • Be between 8 and 20 characters in length
  • Contain at least 1 alpha character
  • Contain at least 1 numeric character
  • Contain at least 1 uppercase character
  • Contain at least 1 lowercase character
  • Contain at least 1 special character
  • NOT contain the same character more than twice
  • NOT contain the user ID
  • NOT be any of the previous 6 passwords

Where can I get more information about Practitioner Identification Numbers (PIN)?

Frequently asked questions regarding Practitioner Identification Numbers (PIN) has been added to the website. View PIN frequently asked questions.

What electronic and digital signatures will Arkansas Medicaid accept?

Medicaid will accept electronic signatures provided the electronic signatures comply with Arkansas Code § 25-31-103 et seq.

Printable Enrollment-Related Forms

Address Change Form (DMS-673)
Change of Ownership Form (DMS-0688)
Contract to Participate in Arkansas Medicaid (DMS-653)
Data Sharing Agreement (DMS-652A)
Electronic Fund Transfer (EFT) Authorization for Automatic Deposit
EPSDT Agreement (DMS-831)
Disclosure of Significant Business Transactions (DMS-689)
Media Selection/Email Address Change Form (MS-005)
Medicaid Primary Care Physician (PCP) Certification and Attestation Form
NPI Reporting Form (DMS-683)
Office of Long Term Care Contract
Ownership and Conviction Disclosure (DMS-675)
PCP Agreement (DMS-2608)
Practitioner Identification Number Request Form (DMS-7708)
Provider Enrollment Application and Contract Packet
Section IV - Group Affiliation
W-9