Section 7 AAC 105.210 - Provider enrollment requirements(a) An eligible provider shall enroll with the department before billing the department for payment of services covered under 7 AAC 105 - 7 AAC 160 that are provided to recipients.(b) To be enrolled in this state, a provider (1) must submit a completed provider enrollment form and provider information submission agreement on forms provided by the department;(2) must verify that the provider meets all other applicable requirements of 7 AAC 105 - 7 AAC 160 and all applicable federal and state licensing and certification requirements;(3) must comply with all federal and state laws as they apply to providing health care or related services to Medicaid recipients in this state, including laws related to recipient confidentiality, electronic transactions, and civil rights;(4) must assume responsibility for all information and claims submitted to the department by that provider or that provider's billing agent;(5) must agree to submit claims in the form or format required by the department for claim submission;(6) must comply with the requirements of AS 47.05.300 - 47.05.390 and 7 AAC 10.900 - 7 AAC 10.990 (barrier crimes and conditions; background checks), if applicable to that provider type; and(7) if an out-of-state provider, must (A) verify enrollment in the Medicaid program in the jurisdiction in which services are provided if Medicaid enrollment is available for that type of provider in that jurisdiction; or(B) provide documentation from the jurisdiction in which the provider provides services that Medicaid enrollment is not available in the jurisdiction for that type of provider.(c) A provider who is practicing under a temporary or locum tenens permit, license, or authorization issued under AS 08, and who is substituting for another provider, being evaluated for permanent employment, or temporarily employed by a facility while it attempts to fill a vacant position must enroll as required in (a) and (b) of this section.(d) The department may disenroll a provider who has not submitted a claim for at least 18 months.(e) The department may enroll a provider with a retroactive effective date of enrollment of up to one year if the provider (1) meets the requirements of this section; and(2) provided services covered under 7 AAC 105 - 7 AAC 160 to a Medicaid recipient during the immediately preceding year for which the provider has not been paid.(f) Not later than 30 days after the change, and on a form specified by the department, an enrolled provider shall notify the department of any change to the information submitted under (b)(l) of this section. Eff. 2/1/2010, Register 193; am 10/1/2011, Register 199; am 6/29/2017,Register 222, July 2017; am 9/1/2017,Register 223, October 2017A copy of the Department of Health and Social Services' provider enrollment form and provider information submission agreement may be obtained from the department's designee, Xerox Business Services, LLC, by telephone at 800-770-5650 (within Alaska but outside Anchorage) or 907-644-6800. The form may be obtained at the Xerox Business Services, LLC website at http://www.medicaidalaska.com or by mail from the following address: Xerox Business Services, LLC, Provider Enrollment, P.O. Box 240808, Anchorage, AK 99524-0808.
Authority:AS 47.05.010
AS 47.05.300
AS 47.07.030
AS 47.07.040