Current through Register Vol. 42, No. 10, July 31, 2024
Section 560-X-6-.07 - Enrollment Of Out Of State Providers(1) An outofstate physician who wishes to participate in the Alabama Medicaid Program must enroll with the Alabama Medicaid Program and be assigned a provider identification number. To do so, the physician should send a written request to Medicaid's fiscal agent, Provider Enrollment Division. The following information must be included in the enrollment application: (b) Address of Place of Business;(c) Provider Type and specialty;(d) Social Security Number;(e) Federal Employer Identification Number;(f) Medicaid license Number;(g) Personal Historical Data; and(h) Original Provider Signature. Author: Janet B. Young
Ala. Admin. Code r. 560-X-6-.07
Rule effective October 1, 1982. Amended: effective May 9, 1984; March 12, 1987. Amended: Filed December 7, 1994; effective January 12, 1995.Statutory Authority: Title XIX, Social Security Act; 42 C.F.R. §§401, et seq.; State Plan.