Section 6401(a) of the Affordable Care Act (ACA) requires the State Medicaid Agency to impose a fee on each “institutional provider of medical or other items, services, and suppliers.” The application enrollment fee amount is the same fee that applies to Medicare enrollment. The enrollment fee does not include non-institutional providers (e.g., Practitioners, Dentist, Group Billers). The purpose of the enrollment fee collected by the State Medicaid Agency is to offset the cost of conducting the required screening for the provider application. The enrollment fee is collected during the new enrollment, revalidation, and reactivation of a disenrolled provider.
The fee amount increases each calendar year and is issued by the Centers for Medicare and Medicaid Services (CMS). The enrollment fee for calendar year 2023 is $688, effective January 1, 2023 through December 31, 2023.
You can review the Provider Enrollment Screening Glossary to identify which providers require the enrollment fee.
To submit the enrollment fee or more detail on how to make the enrollment fee, please select: Make an online payment
During the application process in APEP the institutional provider will encounter six options when an enrollment fee is required to complete the application screening process. Please refer to the options below for helpful information regarding requirements for each option.
Option one, “Pay Fee,” by selecting this option the provider will receive a written notice, along with a six-digit provider id, outlining the steps on how to pay the enrollment fee. Acceptable forms of payment are Visa, Master Card, American Express, Credit/Debit Card. Cash is not an acceptable form of payment.
Note: The six-digit provider id assigned is only to allow the provider to submit the enrollment fee. Once AHCCCS has completed the screening application process an approval notice will generate to the provider.
Option two, “Fee Paid to Medicare,” by selecting this option the provider is indicating the enrollment fee paid to Medicare. Please note this option is subject to additional research conducted by Provider Enrollment to validate the payment, including verifying the provider’s dual enrollment in Medicare. This includes, same name, TIN, practice location, and 5 percent or more owners are reflecting a match with the enrolling provider.
Option three, “Fee Paid to Medicaid in Another State,” by selecting this option the provider is indicating the enrollment fee paid to another State Medicaid Agency. Please note this option requires additional research to validate the payment. Proof of paid enrollment fee to the other state recommended. Use the “Upload Step” to upload proof of payment. If proof is not attainable, Provider Enrollment can attempt to contact the other State Medicaid Agency to validate the payment.
Option four, “Request Hardship Waiver,” by selecting this option the provider is indicating the enrollment fee will cause undue hardship. Please note this option is subject to approval by the Centers of Medicare and Medicaid Systems (CMS). Additional information, including a written letter describing why the hardship justifies an exception to the enrollment fee requirement, and supporting documentation to the State Medicaid Agency such as historical cost reports, recent financial reports such as balance sheets and income statements, cash flow statements, and tax returns will be requested to allow CMS to complete the request and determine if an exception is approved.
Option five, “AHCCCS Prior Payment,” by selecting this option the provider is indicating they have paid the enrollment fee for this provider id. Please note if a provider has multiple provider ids the enrollment fee required for each provider id.
Option six, “Issue Refund,” by selecting this option the provider is requesting a refund to a paid enrollment fee. Please note refunds are only issued if the provider withdrew the application before the screening process was approved (e.g., AHCCCS issued an approval notice); AHCCCS rejects the application during the screening process; provider paid the fee to Medicare or another State Medicaid Agency; AHCCCS could not approve the application due to a temporary moratorium placed on the provider type; provider was approved for an exception as a result of a hardship.
