212.000 Practice Enrollment (Arkansas Medicaid PCMH Manual)212.000 Practice Enrollment (Arkansas...

212.000 Practice Enrollment (Arkansas Medicaid PCMH Manual) A physician may be affiliated with only one participating practice. A participating practice must update the Department of Human Services (DHS) on changes to the list of physicians who are part of the practice. Physicians who are no longer participating with a practice are required to update in writing via email at ARKPCMH@dxc.com within 30 days of the change. The update/change form is located on the Payment Initiative website - http://www.paymentinitiative.org/Websites/paymentinitiative/images/Update-Change%20Form.pdf. This form should be completed and submitted to ARKPCMH@dxc.com when:

• You have a provider leaving your practice • You have a provider joining your practice • Your contact lead(s) contact information changes

mailto:ARKPCMH@dxc.comhttp://www.paymentinitiative.org/Websites/paymentinitiative/images/Update-Change Form.pdfmailto:ARKPCMH@dxc.com