Fee for Service Frequently Asked Questions (FAQs)

FAQs

• How & where do I apply to become a Medicaid provider?
• What documentation do I need to submit with my Provider Participation Agreement (PPA)?
• Why do I need to supply a servicing address as well as a billing address on my Provider Participation Agreement (PPA)?
• I am a physician, and want to know why I am required to submit specialty certification documentation with my provider participation agreement.
• Once I have submitted a Medicaid Provider Participation Agreement (PPA), how long will it be before I am issued a provider number?
• How do I know when I have been approved as a Medicaid provider?
• How will I know what I am responsible for as a Medicaid provider, and how do I bill for services?
• Why was my Medicaid Provider Participation Agreement returned to me unapproved?
• Why was my Medicaid provider number cancelled and how can I get it reinstated?
• I am a Medicaid provider and am moving to another location. Must I submit a new provider participation agreement for this address change?
• We are changing ownership for our facility, with a new name and tax identification number. Do we need to submit a new provider participation agreement?
• I am a Medicaid provider and want to be associated with a hospital or physician group practice. What do I need to do?
• How can I get my Medicaid provider number? My office staff has changed, and I cannot locate my Medicaid number.
• The effective date of my Medicaid provider enrollment is not what I requested.

How & where do I apply to become a Medicaid provider?

You must complete a Provider Participation Agreement (PPA) and send it, along with all required documents, to ACS Provider Enrollment.

ACS - Provider Enrollment
1720-A Randolph Road
Albuquerque, NM  87106

ACS - Provider Enrollment
P.O. Box 27460
Albuquerque, NM 87125-7460

(505) 246-0710

(505) 246-9988

(800) 299-7304

What documentation do I need to submit with my Provider Participation Agreement (PPA)?

When you contact ACS initially to receive a PPA, staff will help you select the Provider Type & Specialtycoding you should use to apply.  You will also be provided with a listing of documents that you will need to submit with your PPA.  It is important to include all of this documentation with your PPA in order for it to be processed within 6-8 weeks.  If the requested documentation is not attached, ACS or MAD staff will either call you or return the PPA to you for follow-up.   The PPA will be denied if the required documentation is not submitted.

Why do I need to supply a servicing address as well as a billing address on my Provider Participation Agreement (PPA)?

For record and file purposes, MAD requires that the PPA contain a servicing address (where services are provided) and a billing address (where payments and correspondence are sent.)  You must inform ACS of any change in address once you become Medicaid provider, so they may update your file.

I am a physician, and want to know why I am required to submit specialty certification documentation with my provider participation agreement.

MAD requires specialty certification for physicians to assure expertise in the specialty area and provide quality services to Medicaid recipients.   This specialty documentation can include national board certification, certification from residency program, or correspondence from the chairperson of a residency program stating that the physician completed necessary training in their specialty area.

Once I have submitted a Medicaid Provider Participation Agreement (PPA), how long will it be before I am issued a provider number?

If the PPA is completed accurately and submitted with all required documentation, ACS will issue a Medicaid provider number within six (6) to eight (8) weeks.  It may take longer if ACS or MAD staff need to contact you for additional information.

How do I know when I have been approved as a Medicaid provider?

You will receive a letter from ACS with your Medicaid provider number.

How will I know what I am responsible for as a Medicaid provider, and how do I bill for services?

Once enrolled, ACS will send you a packet of information which includes Medicaid program policies, billing instructions, utilization review instructions, and other pertinent material specific to your type and specialty.  If you have any questions after review of these documents, contact ACS Provider Enrollment. 

Why was my Medicaid Provider Participation Agreement returned to me unapproved?

A provider participation agreement may be returned for any number of reasons. Contact ACS Provider Enrollment to inquire.

Why was my Medicaid provider number cancelled and how can I get it reinstated?

There could be several reasons for this.  The most common reasons are:

• The provider did not inform ACS or MAD of a change of address; correspondence sent to the provider was returned by the Post Office.  MAD sends correspondence to some 15,000 providers. We cannot verify correct addresses for all returned mail.  The provider must report any change of address to ACS or MAD so that the most current address is on file.
• Your license has expired.  MAD currently enrolls providers through the time that their professional licenses expire.  It is then up to the provider to submit their current license to ACS within 30 days of the termination in order to be reinstated. On or after the 31st day, the provider must submit a new PPA.
• Your facility had a change of ownership with new owners and tax identification number.  The new owners must submit a provider participation agreement in order to receive a new Medicaid provider number.

The provider or MAD representative should contact ACS in order to determine why the number was cancelled.  ACS keeps this information on file.

I am a Medicaid provider and am moving to another location. Must I submit a new provider participation agreement for this address change?

No, you don’t need to submit a new PPA.  You must send a letter to ACS on your letterhead informing them of this address change.  They will update your provider file. If you are moving to a different city, a new city license is required.

We are changing ownership for our facility, with a new name and tax identification number, do we need to submit a new provider participation agreement?

Yes, MAD policy stipulates that when a facility has a change of ownership due to the above-named reasons, the new owners must submit a PPA.  The provider number issued to the previous owner will be cancelled effective the date on which change of ownership occurred.

I am a Medicaid provider and want to be associated with a hospital or physician group practice. What do I need to do?

The hospital or physician group practice must have or be applying for a Medicaid provider number. If you are applying to become a Medicaid provider, you must list the group Medicaid provider number on the PPA Individual Within a Group.

Current Medicaid providers must submit a letter (on your letterhead) to ACS Provider Enrollment. List the name, address, and the group Medicaid provider number with which you want to be associated.

How can I get my Medicaid provider number?  My office staff has changed, and I cannot locate my Medicaid number.

Contact ACS Provider Enrollment or MAD . We can give you your Medicaid provider number over the telephone if you can supply us with your social security number or tax identification number.  If you can't give us this information over the telephone, you must submit a written request on letterhead.  This is necessary to be sure that we give the appropriate information to providers.

The effective date of my Medicaid provider enrollment is not what I requested.

MAD has final authority to assign effective dates for Medicaid provider enrollment.   Effective dates are assigned based upon issue dates of licenses submitted with the PPA and when the PPA is initially received by ACS .