Provider applicants must meet all program requirements and qualifications for which they are seeking enrollment before they can be enrolled as a Medicaid provider. Specific qualifications for each provider type are listed in the Alabama Medicaid Participation Requirements chart. Please review to ensure you meet the minimum enrollment requirements to participate in the Alabama Medicaid program.

To complete an application you will need to know or be able to obtain about the provider applicant all or some of the following information, depending on the type of enrollment you are completing:

• National Provider Identifier
• Basic Business Office Data (i.e., address, phone, fax, email address, etc.)
• Specific Office Data (i.e., CLIA Certification, Name and SSN of employees/personnel, etc.)
• Specific Provider Data (i.e., CLIA Certification, SSN, Licensure Information, etc.)
• IRS Tax Identification Data
• Banking Information
• Group Identification Data (i.e., Name, NPI, Medicaid ID)

The ability to make data corrections after the submission of an application is limited. To avoid rejection of an application please be sure to follow instructions provided and also validate/verify information entered prior to submitting an applicaton.

Please be aware that an application fee may be required prior to your enrollment as an Alabama Medicaid provider. If an application fee has been paid to Medicare or another state or you are currently enrolled in Medicare, another State`s Medicaid Program, or CHIP, proof of such is required to be submitted as part of the supplemental documentation for this enrollment application. If you do not meet one of the above mentioned conditions, you may be required to pay an application fee. Please refer to the Alabama Medicaid Participation Requirements to determine if your provider type is required to submit an application fee.

As pages of the application are completed, additional information may be required, and some documentation may need to be submitted to validate entries. Required supporting documentation can be submitted via the Upload Supporting Documentation feature which is accessible on the Agreement page of the application.

The application can be saved and resumed as needed; however, once a page is accessed, the page must be completed before the application can be saved.

When all pages of the application have been completed, please "Submit” and "Confirm" the application.

Please click the "Continue" button to start the enrollment application.