AHCCCS Provider Registration 
See information on the Change Healthcare response

Get Ready to Enroll: Prerequisite Steps for Providers

A high level checklist of items the provider will need to enroll.

Many providers will need to take action before they are ready to enroll as a Medicaid provider with AHCCCS. To make sure your enrollment experience is as quick and efficient as possible; please investigate whether you need to complete any of these prerequisite steps before you attempt to submit your application.

Obtain a National Provider Identifier (NPI) Number – The federal government requires that providers who administer “medical and other health services” should obtain a NPI number – a unique 10-digit identification number for covered health care providers. For more information visit the National Plan and Provider Enumeration System (NPPES) webpage at https://nppes.cms.hhs.gov or contact the NPI Enumerator at 1-800-465-3203 or TTY 1-800-692-2326.

Ensure a Certified W9 is On File – Any provider who will be receiving state/federal funds for services rendered or provided to Medicaid recipients must have a certified W9 tax form on file with the State.

Renew any Professional Certifications or Licensures – Providers must maintain current certification or licensure as a condition of participation in the Medicaid Program. If your profession requires a certification or licensure in the State of Arizona, these qualifications must be active at the time of enrollment and throughout the duration of the active status of the provider enrollment AHCCCS ID.

Submit the current version of the Provider Enrollment application – AHCCCS revised the provider enrollment application in January 2020 to align with the AHCCCS Provider Enrollment Portal (APEP). Providers should review the application and follow the instructions for completing the application to enroll their existing AHCCCS provider ID.

Submit all supporting documentation – In addition to a complete application, each provider is required to submit all applicable supporting documentation at the time of submission to avoid processing delays.

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