Agency Provider Certification

• ARChoices Provider Certification Application 
• Targeted Case Management Provider Application 
• ARChoices Provider Certification Requirements

New Applicant Instructions

For first-time providers or if applying for a new provider service, follow these steps:

1. Contact the Division of Provider Certification and Quality Assurance (DPSQA) staff to begin your application process.
   Note: If you are applying specifically for personal care services, skip this step and proceed directly to step 3 by contacting the Arkansas Health Department (AHD).
2. After submitting the required documents to DPSQA, you will receive a provisional letter from the Provider Certification Unit.
3. Contact the Arkansas Health Department (AHD) to complete their licensing process by calling 1-800-462-0599. You will need to provide AHD with a copy of the provisional letter received from DPSQA.
4. Verify that you have obtained licensure from AHD before applying for your Medicaid provider identification number. Apply online at: https://portal.mmis.arkansas.gov/armedicaid/provider/Home/ProviderEnrollment/tabid/477/Default.aspx
5. Carefully read the Medicaid regulations for this program prior to submitting your application to Medicaid.
   • Sections I, III, and IV apply to all Medicaid providers.
   • Section II applies specifically to the ARChoices program.
     Providers are responsible for complying with all applicable sections.
6. Once you have reviewed the regulations, submit your application for a Medicaid provider identification number to complete the certification process. Please allow 30 to 60 days for processing.
7. When all steps are completed, the DPSQA Certification Unit will mail you a certificate containing your Provider Identification Number (PIN) and expiration date.

Contact Information
1-866-801-3435 or 501-682-2441