Provider Enrollment Screening Glossary 
See information on the Change Healthcare response

Provider Enrollment Screening Glossary

The Provider Enrollment Screening Glossary is a tool to help determine the following screening requirements:

  • Provider type to services rendered;
  • Enrollment Type (Page 4) AHCCCS Provider Enrollment form: Sections I-A & I-B;
  • NPI requirement;
  • Fee requirement;
  • Site Visit requirement;
  • Fingerprint-Based Criminal Background requirement;
  • Risk Category

When reviewing the Provider Enrollment Screening Glossary, it’s important to select the correct enrollment type at the initial enrollment submission. Outline below are definitions of the available enrollment types listed within the glossary.

  • Individual – Regular Individual/Sole Proprietor or Rendering/Service Provider
  • Group Biller
    • (This enrollment type acts as a “Group Biller Only” provider type 01 (an organization electing to act as a financial representative for any provider or group of providers))
  • Facility/Agency/Organization (FAO-Hospital, Nursing Facility, Various Entities)
  • Contractor/MCO – Managed Care Organization
  • Atypical (non-medical) provider (Choose this option if you do not have a NPI)
    • Individual (Driver, Home Help/Personal Care, Carpenter, etc.)
    • Agency (Child Care Institution, Home Help/Personal Care Agency, Transportation Company, etc.)
Note: For more information regarding Provider Enrollment, please refer to the AHCCCS Medical Policy Manual (AMPM), chapter 610 AHCCCS Provider Qualifications
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