The purpose of Section I is to explain the role the providerplays in the Arkansas Medicaid Program. The information conveyed will providethe users with an understanding of Medicaid program policy. It also containsinformation the provider may need to answer questions that individuals oftenask about the Medicaid Program.
The manual will be an effective tool if it is properlymaintained. The fiscal agent, EDS, will mail each provider all manual updateswhen produced. These updates should be promptly filed in the manual accordingto the procedures discussed in Section 101.100. Information that has not yetbeen incorporated into this manual is issued via Official Notices andRemittance Advice (RA) messages. Official Notices and RAs are filed in the backof this manual.
Arkansas Dhs Form Dco 153
Download File: https://tinourl.com/2vJcwU
All manuals, Official Notices and RAs are also available fordownloading, without charge, from the Medicaid Home Page Web Site atwww.medicaid.state.ar.us.These documents are maintained in separate folders on the WebSite. Downloading all three sets of documents for the program in question willensure the provider of having the most current policy informationavailable.
The manual is designed to accommodate new pages as furtherinterpretations of the law and changes in policy and procedures are made. Thesechanges are released to the provider in the form of a manual update, anOfficial Notice or an RA (remittance advice) message. The fiscal agent, EDS,will issue these changes as directed by the Division of Medical Services (DMS).Periodically, all changes made to Medicaid policy will be promulgated andincorporated into each Medicaid provider manual as policy.
An update transmittal letter will accompany each update to thismanual. Updates will have sequential identification numbers assigned, e.g.,Update Transmittal #1. The transmittal letter identifies the new page numbersto be added and/or the pages to be replaced and provides any other informationabout the update being made. An Update Control Log has been provided in theback of the manual to record updates received. When an update package isreceived, the updated manual pages should be filed in the provider manual,removing the pages being revised. The effective date should be entered on theUpdate Control Log opposite the appropriate update number. When the update iscomplete, the transmittal letter should be filed immediately after the updatecontrol log in ascending sequence by update number.
Section 7 of Act 280 of 1939 and Act 416 of 1977 gave authorityto the State of Arkansas, the Division of Social Services, now referred to asthe Department of Human Services, to establish and maintain a medical careprogram for the indigent. It also gave authority to the Commissioner of SocialServices, now called the Director of the Department of Human Services, to setforth and administer the rules and regulations necessary to carry out such aprogram. Out of this legislation, the Arkansas Medical Assistance Program wasformed.
The Division of Medical Services (DMS) encourages all Medicaidproviders to participate in providing Child Health Services (EPSDT) screeningservices to eligible Medicaid recipients. DMS provides patient outreach,including assistance in scheduling screening appointments and providingtransportation for the recipients to all providers' offices. Except in certaincounties that require a primary care physician (PCP) referral, recipients havefreedom of choice in selecting a provider for screening services.To make certain this occurs, all local county offices will be given lists ofproviders who have agreed to accept referrals and provide Child Health Services(EPSDT) screenings. This list will be updated as additions, deletions andaddress and/or telephone number changes occur. Information regarding PCPreferrals is located in Sections 180 through 187. The list of countiesrequiring a PCP referral is located in Section 184.
Providers billing Medicaid for diagnosis or treatment mustcertify that their services result from a Child Health Services (EPSDT)screening or referral. The certification is a matter of entering "Y" in the"EPSDT Indicator" field in the AEVCS format. Field numbers (#s) and validvalues for each claim type/provider type are:
The Utilization Review Section of the Arkansas Medicaid Programhas the responsibility for assuring quality medical care for its recipientsalong with protecting the integrity of both state and federal funds supportingthe Medical Assistance Program. The tasks of the Utilization Review Section aremandated by federal regulations. To realize completion of the tasks assigned, asystem has been developed which retrospectively evaluates medical practicepatterns by comparing each provider's pattern to norms and limits set by allproviders of the same specialty. This system utilizes the information thatappears on the Medicaid claim. Utilization Review reports are then printed forall providers who exceed the norms or limits established by their peers. Thestaff evaluating these computerized reports are experienced medical reviewanalysts who work under the direction of the Medicaid Program's MedicalDirector, and who have access to the expertise of a Peer Review Committee plusa full complement of specialty consultants on an as-needed basis.
Review analysts may, from time to time, contact a provider tosupply the provider with information from these reports as well as to requestadditional information regarding their medical practice. The provider'scooperation in responding to these contacts will allow for greater accuracy inevaluation.
The purposes of the recipient lock-in rule are to better enablephysicians and pharmacists to provide quality care and to assure that theMedicaid Program does not unintentionally facilitate recipient drug abuse orinjury from overmedication or drug interaction. An eligible recipient, whencorrectly identified by application of a utilization algorithm and clinicalreview to have utilized Medicaid pharmacy services at a frequency or amount notmedically necessary, will be required to select one provider of pharmacyservices and will be informed that Medicaid will deny claims for pharmacyservices submitted by any provider other than the provider selected by therecipient.
EDS, a contractor, performs provider relations and theprocessing of Medicaid claims. EDS Provider Representatives are available toassist providers with detailed billing or policy questions and to scheduleon-site technical assistance with AEVCS and NECS software. To contact arepresentative, providers may call the Provider Assistance Center at 1-800-457-4454 (In-State WATS) or (501) 376-2211 (local or out-of-state).Representatives can be reached directly by calling (501)374-6609.
The Utilization Review Section of the Division of MedicalServices is available to assist providers with questions regarding extension ofbenefits and prior authorization of services for individuals age 21 and over,and for specified services for individuals under age 21, with the exception ofprescription drug prior authorizations. Utilization Review may be contacteddirectly by calling (501) 682-8340. Providers may call 1-800-482 -1141 (tollfree within Arkansas) and leave a message. The call will be returned as soon aspossible. The Personal Care, Inpatient Psychiatric and Home Health Units aresections within Utilization Review. The Arkansas Foundation for Medical Care,Inc. performs medical/surgical prior authorizations. AFMC's telephone numbersare: (501) 649-8501 for general questions, for procedure precertification andlength of stay review (MUMP), 1-800-426 -2234 for In-State and Out-of-State,and (501) 649-0715 in the Fort Smith area.
Medicaid recipients are issued a magnetic identification cardsimilar to a credit card. Each identification card displays a hologram, and formost Medicaid categories, a picture of the recipient. Children under the age offive and nursing home/waiver recipients are not pictured. New recipients of theFamily Planning Wavier (Category 69) are not pictured unless they werecertified using an existing case number and have a previously issued photo IDcard. The Division of County Operations issues the Medicaid identification cardto Medicaid recipients. THE MEDICAID IDENTIFICATION CARD DOES NOTGUARANTEE ELIGIBILITY FOR A RECIPIENT. Payment is subject toverification of recipient eligibility at the time services are provided. Theeligibility transaction is accomplished at the point-of-sale (POS) device byswiping the card and performing a few simple keystrokes. If the recipient doesnot have a Medicaid ID card, the Medicaid identification number can be typedin. This will require a point-of-sale (POS) device, EDS supplied software for apersonal computer (PC) or an office management system modified to process aneligibility verification transaction. Refer to Section 133 for verification ofrecipient eligibility procedures, and to Section 301 for additional POS deviceinformation.
The Division of Medical Services has implemented the AutomatedEligibility Verification and Claims Submission (AEVCS) technology. With AEVCS,Medicaid providers are able to verify a patient's Medicaid eligibility for aspecific date or range of dates, including retroactive eligibility for the pastyear. Providers may obtain other useful information, such as the status ofbenefits used during the current fiscal year, other insurance or Medicarecoverage, etc. See Section III of this manual for further information onAEVCS.
Upon receipt and approval of the above information by theEnrollment Unit, a provider number will be assigned to each approved provider.This number must be used on all claims and correspondence submitted to ArkansasMedicaid.
As a condition for entering into or renewing a provideragreement all applicants must complete this provider application. A true,accurate and complete disclosure of all requested information is required bythe Federal and State Regulations that govern the Medical Assistance Program.Failure of an applicant to submit the requested information or the submissionof inaccurate or incomplete information may result in refusal by the MedicalAssistance program to enter into, renew or continue a provider agreement withthe applicant. Furthermore, the applicant is required by Federal and StateRegulations to update the information submitted on the ProviderApplication. 2ff7e9595c
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