Provider Enrollment and Re-enrollment
Mandatory Re-enrollment Has Begun
The Alaska Department of Health and Social Services’ current Medicaid Management Information System (MMIS) is transitioning to Alaska Medicaid Health Enterprise. The first phase of this transition requires re-enrollment of all active providers* who want to continue participation in the Alaska Medical Assistance Program. Re-enrollment is necessary to collect additional data elements required by the new MMIS and to ensure Alaska Medical Assistance Program records are up-to-date and in compliance with federal and state regulations.
Completing the re-enrollment process will not impact existing provider identification numbers, billing requirements, or Alaska Medicaid claims processing and adjudication for our enrolled provider community at this time.
Online re-enrollment training is available at https://learn.medicaidalaska.com.
Providers who have received their re-enrollment notice containing their unique authorization code can get started with the re-enrollment process at the Alaska Medicaid Provider Enrollment Portal at https://enroll.medicaidalaska.com.
If you have any questions concerning the Alaska Medicaid Health Enterprise re-enrollment process, please contact the Re-enrollment staff at 907.644.5993 or in-state, toll-free at 888.944.6877.
* Providers who initially enrolled after September 1, 2012 may disregard this message.
Who Must Enroll?
Before submitting claims to the Alaska Medical Assistance Program, you must first enroll as a Medical Assistance Provider using the Provider Enrollment Portal (PEP). This includes:
- Providers not currently enrolled in the Alaska Medical Assistance Program
- Providers that are currently enrolled, but who wish to enroll as a different type of provider using their current tax ID
- Providers that wish to enroll as the same provider type but with a new tax ID
Additions or changes to existing provider records can be done by downloading the appropriate form. A general overview of PEP can be found here.
Click here to begin processing a new enrollment.
Online training is available to provide additional guidance.
Enrollment information may also be obtained by calling Xerox,
Provider Services Department at
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New Providers
| Title | Last Modified |
|---|---|
| Dispensing Provider Addendum | 03/02/2012 |
| Electronic Remittance (835) Authorization Form | 03/02/2012 |
| Enrollment Instructions for Community Health Aides/Practitioners | 10/24/2011 |
| Enrollment Instructions for Dental Health Aides/Therapists | 10/24/2011 |
| Home Infusion Therapy Provider Addendum | 03/02/2012 |
| Information Submission Agreements | |
| Mental Health Physician Clinic Provider Addendum | 03/02/2012 |
| Physician Assistant Provider Addendum | 03/02/2012 |
| Physician Provider Addendum | 03/02/2012 |
| Provider Enrollment Glossary | 08/02/2010 |
| Provider Enrollment Portal (PEP) Overview | 03/30/2012 |
| Provider Enrollment Taxonomy Reference | 08/02/2010 |
| Provider Type Reference | 08/02/2010 |
| Residential Psychiatric Treatment Center Provider Addendum | 02/03/2012 |
| Residential Psychiatric Treatment Center Provider Letter of Attestation | 03/02/2012 |
| Retail Pharmacy Provider Addendum | 03/02/2012 |
| School-Based Service Provider Addendum | 03/08/2012 |
Re-Enrollment
| Title | Last Modified |
|---|---|
| Check Affiliation Status - Job Aid | 02/08/2013 |
| Frequently Asked Questions | 02/08/2013 |
| Update Medicaid Provider Information Form | 02/08/2013 |
| Update Medicaid Provider Information Form - Job Aid | 02/08/2013 |
Enrolled Providers
| Title | Last Modified |
|---|---|
| Dispensing Provider Addendum | 03/02/2012 |
| Electronic Remittance (835) Authorization Form | 03/02/2012 |
| Enrolled Provider Social Security Number Submission | 03/02/2012 |
| Federally Qualified Health Center Provider Enrollment Form (Existing Providers Only) | 03/02/2012 |
| Home Infusion Therapy Provider Addendum | 03/02/2012 |
| Information Submission Agreements | |
| Mental Health Physician Clinic Provider Addendum | 03/02/2012 |
| NPI Enrollment Requirements | 08/13/2009 |
| Physician Assistant Provider Addendum | 03/02/2012 |
| Physician Provider Addendum | 03/02/2012 |
| Provider Request to Cancel Alaska Medicaid Enrollment | 08/24/2012 |
| Residential Psychiatric Treatment Center Provider Addendum | 03/02/2012 |
| Residential Psychiatric Treatment Center Provider Letter of Attestation | 03/02/2012 |
| Retail Pharmacy Provider Addendum | 03/02/2012 |
| School-Based Service Provider Addendum | 03/08/2012 |
| Update Medicaid Provider Information Form | 02/08/2013 |
| Update Medicaid Provider Information Form - Job Aid | 02/08/2013 |
