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Visit Forms for Provider Enrollment and Revalidation for ACHN and Primary Care Physicians (PCP) enrollment agreements. Provider Enrollment Contact Information: (888) 223-3630 (Nationwide Toll-Free)
Provider Enrollment Forms and Information. A variety of online and paper forms are available to providers wishing to enroll or revalidate. For help enrolling as a Medicaid provider, contact 1 (888) 223-3630 or (334) 215-0111.
Resume an existing electronic enrollment application that has not been submitted.
The secure site gives providers, clerks and billing agents the opportunity to view Claim and Prior Authorization status as well as Eligibility Verification inquiries and to upload and download standard X12 and NCPDP transactions.
The Alabama Medicaid Interactive secure site is intended for providers, clerks and billing agents. For first time users who have received a Personal Identification Number (PIN) letter, click the Setup Account
Provider Enrollment. If you are a provider of medical services and wish to receive Medicaid reimbursement you must complete the required Medicaid provider enrollment application and enter into a written provider agreement with the Alabama Medicaid Agency.
Provider Enrollment. Information and forms to enroll as an Alabama Medicaid provider.