Provider Enrollment Revalidation WebinarPresented by:Karen Young, AFMCCourtney Tipple, DXCEyvonne Carbage-McCartney, DXCAudrey Orange, DXC

November 8, 2018

AgendaTools and Resources for Provider Application

Video on how to complete online application

Required Documentation Guide

Arkansas Medicaid Provider Portal application instructions

Enrollment FAQs

Printable Enrollment-Related Forms

Live Demo

Things to Know

Contact InformationNote: Please refer to www.Medicaid.mmis.arkansas.org to access Provider Enrollment tools and resources

Arkansas Medicaid website:www.medicaid.mmis.arkansas.gov

Live Demo-HealthCare Provider Portal –https://portal.mmis.arkansas.gov/ARMedicaid/Provider

Things to Know

Scan documents/attachments before you start filling out application(Licenses,

certifications, EFT forms, voided checks, IRS letter, etc.)

Individual applications-ONLY the individual can sign application

Individual’s application can ONLY reflect the W9 of the individual’s information

Linking to a Group-The paper version of Section 4 must be printed, signed and

uploaded with the attachments

EFT Form must be completed for the enrolling provider ONLY

Provider Enrollment cannot accept direct deposit sign up forms from Bank Websites,

CMS Website or any other State Agency. ONLY Arkansas Medicaid Website

ALL new providers must have an EFT on file or their application will not be approved–

11/1/2018 Copyright © 2017 AFMC, Inc. All Rights Reserved.

DXC TechnologyProvider Enrollment Contact information

Monday through Friday (8 a.m.–5 p.m.)

• Toll-free in Arkansas: 800-457-4454 (Option 3)

• Local or out-of-state: 501-376-2211

• Dedicated fax: 501-374-0746

DXC Technology

PO Box 8105

Little Rock, AR 72203-8105