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 907.644.6800 within Anchorage or outside of Alaska and 800.770.5650 from other Alaska locations. Application forms may also be obtained by downloading the appropriate form from the list presented here.

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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