Arizona Provider Enrollment – Frequently Asked Questions

*Note: The information provided within this FAQ page is according to the state, unless otherwise indicated (i.e., some areas indicate “According to CMS/Medicaid”).

For full information regarding Provider Medicaid Enrollment in Arizona, please visit the AHCCCS Provider Enrollment Applications and Revalidations page.

For answers to general questions, please review the FAQs below.

Who is required to enroll in the state Medicaid program?

  • Individuals
  • Groups
  • Facility/Agency/Organization (FAO)

I am enrolled as a participating provider in another state’s Medicaid program. Am I also required to enroll in Arizona’s Medicaid Program to provide services to Medicaid beneficiaries?

Yes. All providers that are billing services for AZ Medicaid members are required to register with the Arizona Medicaid program through the AHCCCS Provider Enrollment Portal (APEP).

How do I enroll?

Navigate to the AHCCCS Provider Enrollment Portal (APEP) website and complete an enrollment application. Paper enrollment applications are accepted in very limited circumstances.

How does my registration relate to billing for services?

You must register with the state using the same identifiers you plan to bill with, i.e., TIN/SSN, Specialty, etc.

*The following items must be in alignment:

  • Your contract with Envolve / Centene Dental and Vision
  • State Registration
  • Billing Set Up / Configuration

Are there additional requirements and screenings based on risk / risk level?

According to CMS/Medicaid:

Requirements by Risk Level:

All Risk Levels:

  • Verify provider meets any applicable Federal regulations or State requirements for the provider type prior to making an enrollment decision.
  • License Verifications.
  • Conduct database checks.

Limited Risks:

  • Site visit.

High Risks:

  • Any provider that has a payment suspension based on a credible allegation of fraud within the last 10 years.
  • Any provider excluded within the past 10 years by HHS-OIG or a State Medicaid Agency (SMA). 
  • Any provider that has a qualifying Medicaid overpayment 
  • The provider is enrolling within 6 months of the date of the lifting of a temporary moratorium that at the time would have barred the provider’s enrollment.

* States may impose additional screening methods “in addition to or more stringent than” those in the regulations. This could result in a change in the risk category assigned for certain types of providers. Providers should check with their SMA to determine their risk category.

Additional requirements based on the provider’s assigned risk level can be found on the AHCCCS website under "General AHCCCS Provider Enrollment Requirements".

What is the enrollment application processing timeframe?

General Enrollment Application: within sixty (60) days from submission.

Expedited Enrollment Application: by email request.

  • Examples of what may justify an expedite include but are not limited to:
    • Emergent medical needs of AHCCCS members such as a transplant or an out-of-state emergency service.
    • The Provider is as Department of Child Safety foster parent.

What is my Enrollment Effective Date? / How is my Enrollment Effective Date determined?

According to the State, the enrollment effective date is the date the application is approved.

A request for retroactive enrollment date can be submitted once the Provider’s Enrollment Application in the AHCCCS Provider Enrollment Portal (APEP) is complete and all required screening steps have been completed.

*Requests for retroactive enrollment dates are reviewed on a case-by-case basis.  Examples of what may justify a retroactive enrollment include, but are not limited to:

  • An emergent medical need of an AHCCCS members such as a transplant or an out-of-state emergency. 
  • A change in provider type, licensure, ownership, or service location which required a new application in APEP.
  • A physician began providing Medicaid covered services at the request of a Managed Care Organization (MCO). 
  • The provider was previously terminated for failure to complete revalidation.
  • *Note: There is no guarantee of approval of a retroactive enrollment.

To request a retroactive enrollment date:  

  • Email APEPTrainingQuestions@azahcccs.gov
  • Email must include: 
    • Subject line must be “Retroactive Enrollment Date”.
    • Provider Name
    • Provider National Provider Identification Number (NPI) 
    • Provider Taxpayer Identification Number (TIN)
    • Application number (located in APEP) 
    • Reason for retroactive enrollment request 
    • Any additional information or supporting documentation that may be needed to complete the request. Failure to submit supporting documentation with the request will result in the request being denied.

How do I find proof of registration?

Your “Welcome Notice” is posted on the AHCCCS Provider Enrollment Portal (APEP) under your inbox/archived documents.

I am enrolled but recently received a letter from the State saying that I need to re-enroll, re-register, or revalidate my information. What do I need to do?

Log in to the AHCCCS Provider Enrollment Portal and complete the re-enrollment, re-registration, or revalidation process. The state is required to review your information and complete screening regularly to comply with Federal regulation. Complete all required steps to remain eligible to bill for Medicaid services.

How often do I need to re-enroll, re-register, or revalidate my information?

Providers must re-register their enrollment every four (4) years to maintain Medicaid billing privileges. AHCCCS reserves the right to request off-cycle revalidations. Providers will receive notification by USPS when it is time to complete the re-registration process.

Keep your information up to date!

Report Changes and Maintain Current License and Certifications: Use APEP to report any changes to your information including, but not limited to:

  • Change in Service Address
  • Changes in Ownership or managing employees
  • Maintain current license & certifications
  • Respond to any requests from AHCCCS about your enrollment information

I received a letter from Envolve / Centene Dental and Vision Services about my registration status. What do I do?

Your state provides us with information about each provider’s registration status regularly. We have received information that your registration is not active.

Validate your state registration status to confirm if there are any outstanding items needed to activate your registration. Remember, you’re required to revalidate your information regularly with the state.

If you have proof of current/valid registration, contact us.

Who do I contact if I have questions about my enrollment/registration or need more information?

If any of my information changes, what do I need to do and who do I need to notify?

Keep your information up to date!

Any time you have a change to your information, be sure to notify us, as well as login to your state portal and update!

Here are some examples of the details you should be sure to keep updated:

  • Office Address (including suite number)
  • Office Hours
  • Mailing Address
  • Phone Number

To check the information that Envolve / Centene Dental and Vision has both in our system and published for you, please visit our Find A Provider tool on our website.

If you find any discrepancies within the Find A Provider tool data, or if anything needs updating, please contact us to report the issue and update.

Keeping your information current is essential for your practice, to ensure claims are processed appropriately, and for the convenience and satisfaction of our members.