(a) An eligible
provider shall enroll with the department before billing the department for
payment of services covered under 7 AAC 105 - 7 AAC 160 that are provided to
recipients.
(b) To be enrolled in
this state, a provider
(1) must submit a
completed provider enrollment form and provider information submission
agreement on forms provided by the department;
(2) must verify that the provider meets all
other applicable requirements of 7 AAC 105 - 7 AAC 160 and all applicable
federal and state licensing and certification requirements;
(3) must comply with all federal and state
laws as they apply to providing health care or related services to Medicaid
recipients in this state, including laws related to recipient confidentiality,
electronic transactions, and civil rights;
(4) must assume responsibility for all
information and claims submitted to the department by that provider or that
provider's billing agent;
(5) must
agree to submit claims in the form or format required by the department for
claim submission;
(6) must comply
with the requirements of
AS
47.05.300 -
47.05.390 and
7 AAC 10.900 -
7 AAC 10.990 (barrier crimes and conditions; background
checks), if applicable to that provider type; and
(7) if an out-of-state provider, must
(A) verify enrollment in the Medicaid program
in the jurisdiction in which services are provided if Medicaid enrollment is
available for that type of provider in that jurisdiction; or
(B) provide documentation from the
jurisdiction in which the provider provides services that Medicaid enrollment
is not available in the jurisdiction for that type of provider.
(c) A provider who is
practicing under a temporary or locum tenens permit, license, or authorization
issued under AS 08, and who is substituting for another provider, being
evaluated for permanent employment, or temporarily employed by a facility while
it attempts to fill a vacant position must enroll as required in (a) and (b) of
this section.
(d) The department
may disenroll a provider who has not submitted a claim for at least 18
months.
(e) The department may
enroll a provider with a retroactive effective date of enrollment of up to one
year if the provider
(1) meets the
requirements of this section; and
(2) provided services covered under 7 AAC 105
- 7 AAC 160 to a Medicaid recipient during the immediately preceding year for
which the provider has not been paid.
(f) Not later than 30 days after the change,
and on a form specified by the department, an enrolled provider shall notify
the department of any change to the information submitted under (b)(l) of this
section.