Please follow the Enrollment Instructions below to become an electronic submitter for Alabama Medicaid.
The following process must be completed in order to be able to submit your claims electronically to AL Medicaid.
Please click on this link to access their online enrollment:
Please click on the "Enrollment Application" link on the left hand side then follow the instructions listed below.
If you have any questions regarding the enrollment process, please contact the Technology Support Center toll-free at (800) 456-1242.
Request Information Page
Please review the requirements and qualifications listed then click "Continue"
In the first drop down for "Enrollment Type" please select your appropriate enrollment type
If you are a Facility, please select "Facility", if you are part of a Group Practice, please select "Group"
If you are a Solo Provider please select "Individual" If you are an Individual who is a part of a Group but you need to apply for your own Submitter ID, please select "IndividualWithinGroup"
Please select your appropriate "Provider Type" from the drop down
The date should automatically have today's date, if not please enter
Please enter your contact information then press "Continue"
Request Information Page when enrolling as an Individual within a Group
(If you did not select that option please skip this section)
Please enter the Group NPI
Please enter the Group Name
Please enter the Group Medicaid number
Provider Enrolment: Specialties
(The Provider Type is established on the Request Information screen. Any subsequent specialties available for the selected provider can be added on this screen)
Please select your appropriate specialties and taxonomy codes
Please select which specialty is primary by checking the box
Specialty choices are dependent on what was chosen in the previous screen
Please select "Add" to add specialty and taxonomy codes that have been selected then press "Continue"
Provider Identification Page
If you selected Individual Provider on the initial screen, please enter the Providers' Name & Demographic information
If you selected Group Provider or Facility on the initial screen, please enter the legal name or the DBA name of your Organization and select the Organization Type
Please enter the Tax Name (this is the legal name registered with the IRS)
Please enter the Tax ID and select either "EIN" or "SSN"
Please fill out the rest of the form with your identification numbers then press "Continue"
Provider Addresses Page
Please select your Address Type from the drop down and check the box if this is your Primary Address
Enter your Address along with your contact information
If your Organization has multiple addresses, please click "Add" and once all have been entered, press "Continue"
Provider EFT Information
(EFT is a participation requirement)
Please enter your Bank and Bank Account information and click "Continue"
Please note: Once this application is complete, you will need to fax and mail with cover sheet, an official EFT Form and a copy of a voided check
Other Information Page
If enrolling an independent nurse practitioner, physician-employed practitioner or nurse midwife, the name and NPI of the collaborating/supervision physician must be entered.
If the provider is enrolling as a pharmacy due to a change in ownership, please provide the pharmacy data
Facility or Groups need to indicate board members
If applicable, enter the information requested
Please Click "Continue"
Please provide answers to all disclosure questions
If the question is not applicable, enter "No"
For all "Yes" answers, provide an explanation in the text box
If disclosure explanation requires more detail that what the text box allows, please contact Provider Enrollment
Once done, please press "Continue"
Provider Enrollment: Agreement
Once done, please check the box to "Accept" and enter the authorized signature & title then press "Submit"
We highly recommend reviewing the Summary page for accuracy and printing the Summary Page for future reference
Press "Confirm" to submit your application for processing
Once the "Confirm" button is selected a confirmation email will be sent to the contact person entered on the application
The application will be assigned a tracking number which we recommend retaining for future reference
You will then be asked to enter the tax ID and password which is used to check the status of the application along with the tracking number
Once the application is submitted and confirmed, a bar-coded cover sheet can be printed for submission with all hard copy materials (fax and/or paper mailings) to the HPES Provider Enrollment office.
(Complete this form after you receive your Trading Partner ID if you wish to receive your Remittance Advice electronically)
Please enter your Provider/Business Name and Demographic information
Please enter your NPI, Tax ID, Medicaid number, and your Trading Partner ID
In the next section, please enter your contact information
The "Provider Agent" section should only be filled out if you want a Billing Service to receive your Remittance Advice
If you will be receiving the Remittance Advice, please skip this section
Please Note: ClaimShuttle is not a Billing Service as we do not do the billing for you
Please enter your NPI and select "Web Download from Health Plan-Direct Access/Download"
You will be downloading your Remittance Advice directly from Medicaid so please skip the Electronic Remittance Advice Clearinghouse Information
Please skip the "Vendor" selection as well
Check the box for "New Enrollment", Sign the Enrollment, Print your Name, Title, and the Date
We recommend faxing this form to the number below for expedited processing
Submitting your Forms
It is recommended that you keep a copy of all the forms you will be submitting for your records. Mail and fax the enrollment forms reflecting original signatures to:
Mail form to: EDS • Attn: EDI Department • P.O. Box 241685 • Montgomery, AL 36124
FAX form to: 334-215-4298 Attn: EDI Department
It is very important that you complete and return the entire enrollment packet as described above. Incomplete enrollments will not be processed and will be purged after 60 days.
Waiting for a Response
Once the application has been received the user will receive a confirmation email. The application will be processed within 2-3 weeks and is contingent on all documentation being received and the accuracy of the information submitted. (Remember that mailing time can take as much as five days).
If neither confirmation nor a returned packet is received after three weeks, please contact the Technology Support Center toll-free at (800) 456-1242.
Once you have received your Submitter ID and password from AL Medicaid please call the ClaimShuttle Support Team at 602-439-2525, and set an appointment for a Mailbox setup. Testing is not required for AL Medicaid.