Provider Enrollment Screening Glossary

Provider Enrollment Screening Glossary

This guide is used to review each available AHCCCS provider type and its applicable enrollment requirements.

National Provider
Enrollment Fee Site Visit Fingerprint-based Criminal
Provider Type Identifier (NPI) Risk
Provider Type Name Enrollment Type Required? Required? Regulatory Agency and Certifications Background Check
Code Required? Category
(Yes/No) (Yes/No) Required?
(Yes/No)

01 Group-Payment ID GROUP Yes No No Limited N/A No

01 Group-Payment ID ATYPICAL-FAO No No No Limited N/A No

Arizona Department of Health Services (ADHS) www.azdhs.gov

02 Hospital FAO Yes Yes No Limited No
Medicare Certification (Survey & Certification –
www.cms.gov
Certification & Compliance)

Arizona Board of Pharmacy & pharmacy.az.gov

03 Pharmacy FAO Yes Yes No Limited No
Drug Enforcement Administration (DEA) Registration deadiversion.usdoj.gov

Arizona Department of Health Services (ADHS) www.azdhs.gov

Laboratory: Clinical Laboratory Improvement Act
www.azdhs.gov
(CLIA)
04 Laboratory FAO Yes Yes Yes Moderate No
Radiology / Medical Imaging: Arizona Radiation
Regulatory Agency (If only non-invasive: supply list www.azdhs.gov/licensing/radiation-regulatory/index.php
of HCPCS for review)

05 Clinic FAO Yes Yes No Limited Arizona Department of Health Services (ADHS) www.azdhs.gov No

Certificate of Necessity
06 Emergency Transportation FAO Yes Yes Yes Moderate www.azdhs.gov No
Arizona Department of Health Services (ADHS)

07 Dentist INDIVIDUAL Yes No No Limited Arizona Board of Dental Examiners dentalboard.az.gov No

08 MD-Physician INDIVIDUAL Yes No No Limited Arizona Board of Medical Examiners www.azmd.gov No

Arizona State Board of Nursing www.azbn.gov

09 Certified Nurse-Midwife (CNM) INDIVIDUAL Yes No No Limited Provider type profile (09) available at provider No
www.azahcccs.gov/apep
registration’s website
10 Podiatrist INDIVIDUAL Yes No No Limited Arizona State Board of Podiatry Examiners podiatry.az.gov No

11 Psychologist INDIVIDUAL Yes No No Limited Arizona Board of Psychologist Examiners psychboard.az.gov No

Arizona State Board of Nursing www.azbn.gov
12 Certified Registered Nurse Anesthetist INDIVIDUAL Yes No No Limited American Association of Nurse Anesthetists No
www.aana.com
(AANA/NBCRNA)
13 Occupational Therapist INDIVIDUAL Yes No No Limited Arizona Board of Occupational Therapy Examiners ot.az.gov No

14 Physical Therapist INDIVIDUAL Yes No Yes Moderate Arizona State Board of Physical Therapy ptboard.az.gov No

PEP-903 (rev 09/03/2024) Page 1 of 8

 Provider Enrollment Screening Glossary

Provider Enrollment Screening Glossary

This guide is used to review each available AHCCCS provider type and its applicable enrollment requirements.

National Provider
Enrollment Fee Site Visit Fingerprint-based Criminal
Provider Type Identifier (NPI) Risk
Provider Type Name Enrollment Type Required? Required? Regulatory Agency and Certifications Background Check
Code Required? Category
(Yes/No) (Yes/No) Required?
(Yes/No)

15 Speech/Hearing Therapist INDIVIDUAL Yes No No Limited Arizona Department of Health Services (ADHS) www.azdhs.gov No

16 Chiropractor INDIVIDUAL Yes No No Limited Arizona Board of Chiropractic Examiners chiroboard.az.gov No

17 Naturopath Physician INDIVIDUAL Yes No No Limited Arizona Board of Naturopathic Physicians Examiners nd.az.gov No

Arizona Regulatory Board of Physician Assistants www.azpa.gov

18 Physicians Assistant INDIVIDUAL Yes No No Limited If Behavioral Health Medical Practitioner: Provider No
type profile (18) available at provider registration’s www.azahcccs.gov/apep
website

Arizona State Board of Nursing

19 Registered Nurse Practitioner INDIVIDUAL Yes No No Limited www.azbn.gov No
(both RN & NP license types are required)

20 Respiratory Therapist INDIVIDUAL Yes No No Limited Arizona State Board of Respiratory Care Examiners respiratoryboard.az.gov No

Arizona Department of Health Services (ADHS) & www.azdhs.gov

22 Nursing Home FAO Yes Yes Yes High Yes
Medicare Certification (Survey & Certification –
www.cms.gov
Certification & Compliance)

Arizona Department of Health Services (ADHS) www.azdhs.gov

23 Home Health Agency FAO Yes Yes Yes High Yes
Medicare Certification (Survey & Certification –
www.cms.gov
Certification & Compliance)

Arizona Department of Economic Security (DES) des.az.gov

Group Home (Developmentally
25 ATYPICAL-FAO No No No Limited No
Disabled)
Arizona Department of Health Services (ADHS) www.azdhs.gov

27 Adult Day Health ATYPICAL-FAO No Yes No Limited Arizona Department of Health Services (ADHS) www.azdhs.gov No

Non-Emergency Transportation
28 ATYPICAL-FAO No Yes Yes High Refer to Arizona Health Care Cost Containment System – Provider Enrollment Yes
Providers

Arizona Department of Health Services (ADHS) &

29 Community/Rural Health Center FAO Yes Yes No Limited www.azdhs.gov No
Proof of RHC Designation

30 Durable Medical Equipment Supplier FAO Yes Yes Yes High N/A Yes

31 DO-Physician Osteopath INDIVIDUAL Yes No No Limited Arizona Board of Osteopathic Examiners www.azdo.gov No

PEP-903 (rev 09/03/2024) Page 2 of 8

 Provider Enrollment Screening Glossary

Provider Enrollment Screening Glossary

This guide is used to review each available AHCCCS provider type and its applicable enrollment requirements.

National Provider
Enrollment Fee Site Visit Fingerprint-based Criminal
Provider Type Identifier (NPI) Risk
Provider Type Name Enrollment Type Required? Required? Regulatory Agency and Certifications Background Check
Code Required? Category
(Yes/No) (Yes/No) Required?
(Yes/No)

32 Medical Foods ATYPICAL-FAO No Yes No Limited Refer to Arizona Health Care Cost Containment System – Provider Enrollment No

Arizona Department of Health Services (ADHS) www.azdhs.gov

35 Hospice FAO Yes Yes Yes High Yes
Medicare Certification (Survey & Certification –
www.cms.gov
Certification & Compliance)

36 Assisted Living Home (Formerly ACH) ATYPICAL-FAO No Yes No Limited Arizona Department of Health Services (ADHS) www.azdhs.gov No

CPR & First Aid Certification

ATYPICAL-
37 Homemaker No No No Limited Provider type profile (37) available at provider www.azahcccs.gov/apep No
INDIVIDUAL
registration’s website

39 Habilitation Provider ATYPICAL-FAO No Yes No Limited Arizona Department of Economic Security (DES) www.des.az.gov No
ATYPICAL-
39 Habilitation Provider No No No Limited N/A No
INDIVIDUAL
40 Attendant Care (Companies Only) ATYPICAL-FAO No Yes No Limited Refer to Arizona Health Care Cost Containment System – Provider Enrollment No

Arizona Department of Health Services (ADHS) www.azdhs.gov

41 Dialysis Clinic FAO Yes Yes No Limited No
Medicare Certification (Survey & Certification –
www.cms.gov
Certification & Compliance)

Arizona Department of Health Services (ADHS) www.azdhs.gov

43 Ambulatory Surgical Center FAO Yes Yes No Limited No
Medicare Certification (Survey & Certification –
www.cms.gov
Certification & Compliance)

44 Environmental (LTC) ATYPICAL-FAO No Yes No Limited Arizona Registrar of Contractors roc.az.gov No

Independent Registered Nurse Letter of Intent from Health Plan

46 INDIVIDUAL Yes No No Limited www.azbn.gov No
(Private-RN/LPN) & Arizona State Board of Nursing
ATYPICAL-
47 Registered Dietician No No No Limited Commission on Dietetic Registration www.cdrnet.org No
INDIVIDUAL
ATYPICAL-
48 Nutritionist No No No Limited Refer to Arizona Health Care Cost Containment System – Provider Enrollment No
INDIVIDUAL

49 Assisted Living Center ATYPICAL-FAO No Yes No Limited Arizona Department of Health Services (ADHS) www.azdhs.gov No

PEP-903 (rev 09/03/2024) Page 3 of 8

 Provider Enrollment Screening Glossary

Provider Enrollment Screening Glossary

This guide is used to review each available AHCCCS provider type and its applicable enrollment requirements.

National Provider
Enrollment Fee Site Visit Fingerprint-based Criminal
Provider Type Identifier (NPI) Risk
Provider Type Name Enrollment Type Required? Required? Regulatory Agency and Certifications Background Check
Code Required? Category
(Yes/No) (Yes/No) Required?
(Yes/No)

50 Adult Foster Care ATYPICAL-FAO No No No Limited Arizona Department of Health Services (ADHS) www.azdhs.gov No

53 Supervisory Care Home ATYPICAL-FAO No No No Limited Arizona Department of Health Services (ADHS) www.azdhs.gov No

Arizona Board of Dental Examiners dentalboard.az.gov

54 Affiliated Dental Hygienist INDIVIDUAL Yes No No Limited Provider type profile (54) available at provider No
www.azahcccs.gov/apep
registration’s website

55 Hotels ATYPICAL-FAO No Yes No Limited Refer to Arizona Health Care Cost Containment System – Provider Enrollment No

56 Boarding Home ATYPICAL-FAO No Yes No Limited Refer to Arizona Health Care Cost Containment System – Provider Enrollment No

61 Eye Bank ATYPICAL-FAO No Yes No Limited U.S. Food and Drug Administration (FDA) www.fda.gov/drugs No

62 Audiologist INDIVIDUAL Yes No No Limited Arizona Department of Health Services (ADHS) www.azdhs.gov No

67 Perfusionist INDIVIDUAL Yes No No Limited American Board of Cardiovascular Perfusion www.abcp.org No

68 Homeopathic INDIVIDUAL Yes No No Limited Arizona Board of Homeopathic Examiners homeopath.az.gov No

69 Optometrist INDIVIDUAL Yes No No Limited Arizona State Board of Optometry optometry.az.gov No

County Health Services

70 Home Delivered Meals ATYPICAL-FAO No Yes No Limited Or www.azdhs.gov No
Arizona Department of Health Services (ADHS)

Arizona Department of Health Services (ADHS) www.azdhs.gov

Behavioral Health Provider Certification and Transmittal (BH C&T)

71 Psychiatric Hospital FAO Yes Yes No Limited No
Medicare Certification (Survey & Certification –
www.cms.gov
Certification & Compliance)

Arizona Department of Health Services (ADHS) www.azdhs.gov

77 Behavioral Outpatient Clinic FAO Yes Yes Yes High Yes
Behavioral Health Provider Certification and Transmittal (BH C&T)

Arizona Department of Health Services (ADHS) www.azdhs.gov

Mental Health Residential Treatment
78 FAO Yes Yes No Limited No
Center
Behavioral Health Provider Certification and Transmittal (BH C&T)

79 Vision Center FAO Yes Yes No Limited N/A No

81 EPD HCBS ATYPICAL-FAO No Yes No Limited Refer to Arizona Health Care Cost Containment System – Provider Enrollment No

PEP-903 (rev 09/03/2024) Page 4 of 8

 Provider Enrollment Screening Glossary

Provider Enrollment Screening Glossary

This guide is used to review each available AHCCCS provider type and its applicable enrollment requirements.

National Provider
Enrollment Fee Site Visit Fingerprint-based Criminal
Provider Type Identifier (NPI) Risk
Provider Type Name Enrollment Type Required? Required? Regulatory Agency and Certifications Background Check
Code Required? Category
(Yes/No) (Yes/No) Required?
(Yes/No)

82 Surgical First Assistant INDIVIDUAL Yes No No Limited Refer to Arizona Health Care Cost Containment System – Provider Enrollment No

Arizona Department of Health Services (ADHS) www.azdhs.gov

83 Free-Standing Birthing Center FAO Yes Yes No Limited No
Commission for the Accreditation of Freestanding
birthcenteraccreditation.org
Birth Centers

84 Licensed Midwife INDIVIDUAL Yes No No Limited Arizona Department of Health Services (ADHS) www.azdhs.gov No
Licensed Clinical Social Worker
85 INDIVIDUAL Yes No No Limited Arizona Board of Behavioral Health Examiners www.azbbhe.us No
(LCSW)
86 Licensed Marriage & Family Therapist INDIVIDUAL Yes No No Limited Arizona Board of Behavioral Health Examiners www.azbbhe.us No
Licensed Professional Counselor
87 INDIVIDUAL Yes No No Limited Arizona Board of Behavioral Health Examiners www.azbbhe.us No
(LPC)
92 School Based Bus Transportation ATYPICAL-FAO No Yes No Limited Refer to Arizona Health Care Cost Containment System – Provider Enrollment No

CPR and First Aid certification (on-line training is not

ATYPICAL- valid for registration)
93 School Based Attendant Care No No No Limited www.azahcccs.gov/shared/Downloads/MedicalPolicyManual/700/710.pdf
No
INDIVIDUAL Refer to the AMPM policy 710, for details regarding
certification standards.

94 School Based Nurse (RN/LPN) INDIVIDUAL Yes No No Limited Arizona State Board of Nursing www.azbn.gov No
Non-Medicare Certified Home Health
95 FAO Yes Yes Yes High Arizona Department of Health Services (ADHS) www.azdhs.gov Yes
Agencies

Arizona Department of Health Services/ Bureau of

97 Air Transportation FAO Yes Yes No Limited www.azdhs.gov No
Emergency Medical Services and Trauma System

99 EVS/Non-Service Provider CONTRACTOR/MCO No No No Limited N/A No

Arizona Health Care Cost Containment System
A3 Community Service Agency FAO Yes Yes Yes Moderate www.azahcccs.gov No
AMPM Policy 965

Licensed Independent Substance

A4 INDIVIDUAL Yes No No Limited Arizona Board of Behavioral Health Examiners www.azbbhe.us No
Abuse Counselor (LISAC)

Child Services: Arizona Department of Child Safety

dcs.az.gov
(DCS)
A5 Behavioral Health Therapeutic Home FAO Yes Yes No Limited Adult Services: Arizona Department of Health No
www.azdhs.gov
Services (ADHS)
Behavioral Health Provider Certification and Transmittal (BH C&T)
Child Services: Arizona Department of Child Safety
dcs.az.gov
(DCS)
A5 Behavioral Health Therapeutic Home INDIVIDUAL Yes No No Limited Adult Services: Arizona Department of Health No
www.azdhs.gov
Services (ADHS)
Behavioral Health Provider Certification and Transmittal (BH C&T)

PEP-903 (rev 09/03/2024) Page 5 of 8

 Provider Enrollment Screening Glossary

Provider Enrollment Screening Glossary

This guide is used to review each available AHCCCS provider type and its applicable enrollment requirements.

National Provider
Enrollment Fee Site Visit Fingerprint-based Criminal
Provider Type Identifier (NPI) Risk
Provider Type Name Enrollment Type Required? Required? Regulatory Agency and Certifications Background Check
Code Required? Category
(Yes/No) (Yes/No) Required?
(Yes/No)

Adult Services: Arizona Department of Health

Rural Substance Abuse Transitional www.azdhs.gov
A6 FAO Yes Yes No Limited Services (ADHS) No
Agency
Behavioral Health Provider Certification and Transmittal (BH C&T)
Adult Services: Arizona Department of Health
www.azdhs.gov
A8 Individual Home Respite (IHR) FAO Yes Yes No Limited Services (ADHS) No
Behavioral Health Provider Certification and Transmittal (BH C&T)
Adult Services: Arizona Department of Health
Residential Treatment Center - Secure www.azdhs.gov
B1 FAO Yes Yes No Limited Services (ADHS) No
(17+ Beds) (IMD)
Behavioral Health Provider Certification and Transmittal (BH C&T)
Adult Services: Arizona Department of Health
Residential Treatment Center Non- www.azdhs.gov
B2 FAO Yes Yes No Limited Services (ADHS) No
Secure (1-16 Beds)
Behavioral Health Provider Certification and Transmittal (BH C&T)
Adult Services: Arizona Department of Health
Residential Treatment Center Non- www.azdhs.gov
B3 FAO Yes Yes No Limited Services (ADHS) No
Secure (17+ Beds) (IMD)
Behavioral Health Provider Certification and Transmittal (BH C&T)
Adult Services: Arizona Department of Health
www.azdhs.gov
B5 Subacute Facility (1-16 Beds) FAO Yes Yes No Limited Services (ADHS) No
Behavioral Health Provider Certification and Transmittal (BH C&T)
Adult Services: Arizona Department of Health
www.azdhs.gov
B6 Subacute Facility (17+Beds)(IMD) FAO Yes Yes No Limited Services (ADHS) No
Behavioral Health Provider Certification and Transmittal (BH C&T)
Adult Services: Arizona Department of Health
www.azdhs.gov
B7 Crisis Services Provider FAO Yes Yes No Limited Services (ADHS) No
Behavioral Health Provider Certification and Transmittal (BH C&T)
Adult Services: Arizona Department of Health
www.azdhs.gov
B8 Behavioral Health Residential Facility FAO Yes Yes Yes High Services (ADHS) Yes
Behavioral Health Provider Certification and Transmittal (BH C&T)
BC Board Certified Behavior Analyst INDIVIDUAL Yes No No Limited Arizona Board of Psychologist Examiners psychboard.az.gov No

Federally Qualified Health Center Arizona Department of Health Services (ADHS)

C2 FAO Yes Yes No Limited www.azdhs.gov No
(FQHC) & Proof of FQHC designation

C4 Specialty Per Diem Hospitals FAO Yes No No Limited Arizona Department of Health Services (ADHS) www.azdhs.gov No
638 Federally Qualified Health Center
C5 FAO Yes Yes No Limited Refer to Arizona Health Care Cost Containment System – Provider Enrollment No
(FQHC)
Community Health Worker Arizona Department of Health Services (for Community Health workers employed by the
CH ATYPICAL-FAO No Yes Yes High Yes
Organizations organization)

PEP-903 (rev 09/03/2024) Page 6 of 8

 Provider Enrollment Screening Glossary

Provider Enrollment Screening Glossary

This guide is used to review each available AHCCCS provider type and its applicable enrollment requirements.

National Provider
Enrollment Fee Site Visit Fingerprint-based Criminal
Provider Type Identifier (NPI) Risk
Provider Type Name Enrollment Type Required? Required? Regulatory Agency and Certifications Background Check
Code Required? Category
(Yes/No) (Yes/No) Required?
(Yes/No)

Arizona State Board of Nursing

CN Clinical Nurse Specialist INDIVIDUAL Yes No No Limited www.azbn.gov No
(both RN & NP license types are required)

DU Doula INDIVIDUAL Yes No No Limited Arizona Department of Health Services (ADHS) www.azdhs.gov No

Arizona Department of Health Services (ADHS) www.azdhs.gov

Accredited by the American Academy of Sleep
aasm.org
Medicine (AASM)
E1 Independent Testing Facilities FAO Yes Yes No Limited No
Additional registration options are included on the
provider type profile (E1) available at provider www.azahcccs.gov/apep
registration's website

Arizona Department of Health Services (ADHS) www.azdhs.gov

ED Free Standing Emergency Department FAO Yes No No Limited No
Medicare Certification (Survey & Certification –
www.cms.gov
Certification & Compliance)

ES Enhanced Shelter ATYPICAL FAO No Yes Yes* High H2O Credential Approval Notice Yes
N/A
F1 Fiscal Intermediaries ATYPICAL-FAO No Yes No Limited Provider type is intended for AHCCCS’ Internal Use Only. No
Applications are subject to review and approval.

HA Statewide Housing Administrator ATYPICAL-FAO No No No Limited Valid contract with AHCCCS as the Statewide Housing Administrator No

HO H2O Provider ATYPICAL-FAO No Yes Yes* High H2O Credential Approval Notice Yes

Adult Services: Arizona Department of Health

www.azdhs.gov
IC Integrated Clinics FAO Yes Yes Yes High Services (ADHS) Yes
Behavioral Health Provider Certification and Transmittal (BH C&T)
NA NEMT - Non-Ambulance Air ATYPICAL-FAO No Yes No Limited Federal Aviation Administration Certificate(s) 133 & 135 No

NE NEMT - Equine ATYPICAL-FAO No Yes No Limited Refer to Arizona Health Care Cost Containment System – Provider Enrollment No

NEMT-TNC Transportation Network

NT ATYPICAL-FAO No Yes Yes Moderate Arizona Department of Transportation (ADOT) Permit (A.R.S. §28- 9552) No
Company
OR Prescribing/Ordering Only INDIVIDUAL or FAO Yes No No Limited deadiversion.usdoj.gov No
Drug Enforcement Administration (DEA) Registration
SA Speech Language Pathology Assistant INDIVIDUAL Yes No No Limited Arizona Department of Health Services (ADHS) www.azdhs.gov No

TR Treat & Refer ATYPICAL-FAO Yes Yes Yes Moderate Arizona Department of Health Services (ADHS) www.azdhs.gov No

TS Travel Services ATYPICAL-FAO No No No Limited AHCCCS vendor contract required No

* The site visit for an H2O provider is conducted by the H2O Program Administrator.

PEP-903 (rev 09/03/2024) Page 7 of 8

 Acronym Expansion

American Association of Nurse Anesthetists/National Board of

AANA/NBCRNA
Certification and Recertification for Nurse Anesthetists

AASM American Academy of Sleep Medicine

ACH Adult Care Home
ADHS Arizona Department of Health Services
ADOT Arizona Department of Transportation
AHCCCS Arizona Health Care Cost Containment System
AMPM Arizona Medical Policy Manual
APEP AHCCCS Provider Enrollment Portal
BBHE Board of Behavioral Health Examiners
BH C&T Behavioral Health Provider Certification & Transmittal
CHWO Community Health Worker Organization
CLIA Clinical Laboratory Improvement Act
CMS Centers for Medicare and Medicaid Services
CNM Certified Nurse Midwife
CPR Cardiopulmonary Resuscitation
DCS Department of Child Safety
DEA Drug Enforcement Administration
DES Department of Economic Security
DHS Department of Health Services
DME Durable Medical Equipment
DO Doctor of Osteopathic Medicine
EPD HCBS Elderly and Physically Disabled Home and Community Based Services
EVS Environmental Services
FAO Facility/Agency/Organization
FDA Food and Drug Administration
FQHC Federally Qualified Health Center
H2O Health and Housing Opportunities
HCPCS Healthcare Common Procedure Coding System
IHR Individual Home Respite
IMD Institution for Mental Diseases
LCSW Licensed Clinical Social Worker
LISAC Licensed Independent Substance Abuse Counselor
LPC Licensed Professional Counselor
LPN Licensed Practical Nurse
LTC Long-Term Care
MCO Managed Care Organization
MD Doctor of Medicine
NEMT Non-Emergency Medical Transportation
Non-Emergency Medical Transportation - Transportation Network
NEMT-TNC
Company
NP Nurse Practitioner
NPI National Provider Identifier
RHC Rural Health Center
RN Registered Nurse