Arkansas Department of Human Services logoFront Line
User-Centric design, one-touch, data access, MITA process steps, custom personal favorites

Billing Matters

Even though the majority of these items have been covered previously in provider training and webinars, the Billing Matters section of Front Line was developed to highlight billing changes in the new MMIS. These billing tips will help you remember what is changing and whether billing incorrectly will result in a denied claim.

Billing Changes that Affect Most Provider Types

Change Description
Aid Categories to new Benefit Plans Crosswalk Aid Categories (Section I [124.000] of your billing manual (Word, new window)) are now known as “Benefit Plans.” View or print the aid category to benefit plan crosswalk (PDF, new window), the dental-specific benefit plans crosswalk (PDF, new window) or the vision-specific benefit plans crosswalk (PDF, new window). Benefit plans will replace aid categories in Section I of all provider manuals.
Adjustment Form The new HP-AR-004 Adjustment Request Form (PDF, new window), along with your updated claim must but be submitted for paper adjustment claims to DXC Technology.

Paper adjustments received using the old form will be returned for resubmission using the new process. This change is for submitting adjustments on PAPER only.

If you mailed a paper adjustment before November 1, 2017, it will be processed in the order it was received. Adjustments and reversals can be entered into the new HealthCare Provider Portal beginning November 1, 2017, to avoid paper submission.
Capitation Fee Payments Managed Care capitation and administrative fee payments will no longer be paid through system-generated claims and reported via Remittance Advice. Managed Care Providers will receive an 820 Payment Register as record of these payments. You must have a Trading Partner ID to download these reports. Follow the step-by-step instructions on the “Trading Partner ID Enrollment” MMIS job aid. (PDF, new window) Step 16 outlines how to link your trading partner ID if you have already registered for the HealthCare Provider Portal.
Claim Edits The new MMIS edits claims according to National Correct Coding Initiative (NCCI) standards. This means that some claims will process differently than they did previously. Example – EOB codes will be different in the new system.
Claims Search – HealthCare Provider Portal All claims (from the legacy MMIS in addition to the new MMIS) can be viewed on the HealthCare Provider Portal.
HealthCare Provider Portal Registration Providers must register to gain access to the new HealthCare Provider Portal.
Lab Procedures – QW Modifier Arkansas Medicaid processes lab procedures according to CMS guidelines for CLIA. The guidelines for procedure codes that require the QW modifier can be found on the Categorization of Tests webpage of the CMS website. (HTML, new window) Please refer to the list of waived tests (PDF, new window) to know how to correctly bill lab procedure codes as it pertains to the QW modifier.
New Medicare/Medicaid Crossover Forms Crossover claims can easily be submitted on the HealthCare Provider Portal instead of on paper. Proprietary crossover claim forms will no longer be used. Providers will submit paper crossover claims on either CMS-1500 or CMS-1450 (UB04) along with DMS-600 – Medicare EOMB Information. View or print form DMS-600 found in Section V of your billing manual. (Word, new window)
Provider Electronic Solutions (PES) software Any version of PES prior to 2.25 will not work with the new MMIS. View or print the transition guide for details on upgrading and using PES 2.25 with the new MMIS. (PDF, new window)
Prior Authorization Editing Prior Authorization requests cannot be edited or changed after clicking the “Submit” button. Please ensure required fields are completed appropriately. Once the “Submit” button is selected, no further edits can be made to any fields. If changes are required after the “Submit” button is selected, you must call the State Analyst to void the incorrect PA request and then resubmit a new PA request.
Prior Authorizations – HealthCare Provider Portal All PAs can be viewed on the Healthcare Provider Portal for up to three years – even those submitted previously.
Prior Authorization Tracking Each Prior Authorization request will have a unique, numeric identifier. This number will be assigned by the new MMIS when the PA request is created for all media types.
Prior Authorization Type The new system will require providers to select a process type upon the initial request for prior authorization. This allows the prior authorization request to be systematically sent to the correct area for review and decision. If you request your PA type through Beacon Health or AFMC, you will continue to use same process.

Only the following PA types are available on the HealthCare Provider Portal:
  • 101 – Personal Care
  • 102 – Private Duty Nursing
  • 103 – Adult Dental
  • 104 – Child Dental
  • 105 – Orthodontics
  • 107 – Hearing Services
  • 108 – Augmentative Communication Device Evaluation
  • 109 – Disposable Medical Supplies
  • 110 – Home Health Visit Extensions
  • 111 – Other prosthetics
  • 112 – Other medical service
  • 114 – Specialized Service
  • 115 – IndependentChoices
  • 116 – Vision
  • 150 – DDS/ACS waiver
  • 151 – DDS services
  • 152 – Developmental Rehab Services
  • 153 – Title V
  • 154 – First Connections
Provider Enrollment Application Signatures Providers can now complete and sign their applications electronically on the HealthCare Provider Portal – there’s no longer a need to send anything on paper.
Rejected Claims Claims that rejected in the legacy MMIS will show as denied claims in the new MMIS. These claims can be resubmitted on the same day of the denial.
Remittance Advice Availability A provider’s Remittance Advices will be available on the Provider Portal for up to 7 years beginning October 30, 2017, going forward.
Remittance Advice Changes Remittance Advices will look a little different, but contain the same information. Please take note of the following changes:
  • Current RA “Financial Items” section – Non-related expenditures and accounts receivables (AR) are both listed in the section on the current RA. There is also a reference filed to identify the AR or expenditure and an EOB that is defined on the Summary page.
  • New RAFinancial Transactions (PDF, new window)” section – On the new RA, there will be separate sections for expenditures and ARs. Expenditures will have a field titled “External Request ID” to identify them. However, this field will not be in the AR section. Reason Codes (instead of EOBs) for the ARs and expenditures will be indicated on the RA. They will not be defined on the Summary page, however.
Suspended Claim Denials If a provider had a suspended claim in the legacy MMIS at Go-live, the claim denied with “EOB 755 – Denied and Resubmitted in the New System.” You do not need to resubmit this claim.
Unlimited Claim Details Unlimited claim details can be billed in the new MMIS.
Unsolicited 277 Response The Unsolicited 277 Response is no longer be available. To get a 277 Response, you must have a 276 Transaction. Other options are checking claim status by using the Search Claims option on the HealthCare Provider Portal or Voice Response System (VRS).

Billing Changes by Provider Type

Ambulatory Surgical Centers (ASC) Providers

Change Description
CPT/UB04 Surgery Codes The legacy MMIS used CPT codes on the UB04 for the inpatient institutional abortion surgery coding. Beginning November 1, 2017, Arkansas Medicaid no longer accept CPT surgery codes for any inpatient institutional claim and will require ICD-10 PCS for all procedure coding on inpatient institutional claims.
View policy changes related to CPT/UB04 Surgery Codes. (PDF, new window)

ARKids First-B Providers

Change Description
Z Code Conversion Z codes are being crosswalked to national codes where necessary.
View policy changes related to Z codes crosswalked to national codes. (PDF, new window)

Dental Providers

Change Description
Rendering Provider Taxonomy This is a REQUIRED field on electronic transactions (837D). If this is not on your claim, then it will deny. Please have your billing company add to your electronic transaction per the companion guides located on the Medicaid website. (HTML, new window)

Federally Qualified Health Center Providers

Change Description
Z Code Conversion Z codes are being crosswalked to national codes where necessary.
View policy changes related to Z codes crosswalked to national codes. (PDF, new window)

Hemodialysis Providers

Change Description
Condition Code AN The Hospital provider manual has been updated and no longer states providers must use condition code AN for newborn charges/bills. This condition code was outdated; condition code 81 is used nationally for newborn charges/bills. View policy changes related to Condition Code AN. (PDF, new window)

Hospice Providers

Change Description
Hospice in Long Term Care Claims Hospice providers must put the facility ID in the correct facility field for hospice claims to price correctly when a member is in a LTC facility.

  • HealthCare Provider Portal: Enter the facility ID NPI in the Institutional Provider ID field.
  • PES: Enter the facility ID NPI in the Facility ID field.
  • EDI: Enter the facility ID NPI in Loop ID – 2310E Service Facility
  • Paper: Enter the facility ID NPI or MCD in field 78 Other.

Hospital Providers

Change Description
Condition Code AN The Hospital provider manual has been updated and no longer states providers must use condition code AN for newborn charges/bills. This condition code was outdated; condition code 81 is used nationally for newborn charges/bills. View policy changes related to Condition Code AN. (PDF, new window)
CPT/UB04 Surgery Codes The legacy MMIS used CPT codes on the UB04 for the inpatient institutional abortion surgery coding. Beginning November 1, 2017, Arkansas Medicaid no longer accept CPT surgery codes for any inpatient institutional claim and will require ICD-10 PCS for all procedure coding on inpatient institutional claims.
View policy changes related to CPT/UB04 Surgery Codes. (PDF, new window)
Z Code Conversion Z codes are being crosswalked to national codes where necessary.
View policy changes related to Z codes crosswalked to national codes. (PDF, new window)

Hyperalimentation Providers

Change Description
Z Code Conversion Z codes are being crosswalked to national codes where necessary.
View policy changes related to Z codes crosswalked to national codes. (PDF, new window)

Long Term Care Providers

Change Description
Attending Physician This field is a required field in the new system. If the attending physician is not indicated on the long term care claim/transaction, then it will deny.
LTC Facility Billing Reminders Nursing Home (NH) or ICF/IID services are priced using the per diem rates attached to the Provider ID billing for the specific DOS range on the claim detail line. For hospice providers billing for beneficiaries who reside in a NH or ICF/IID, the Provider ID placed in the Facility ID field is used to determine the correct per diem rate. ICF/IIDs should use the revenue codes designated for ICF/IID.

There are two types of NH rates and two sets of revenue codes to use in order to be paid the correct rate:

1. Traditional rates for non-Homestyle NH services
    (below is a list of valid Traditional Revenue Codes)

Revenue CodeDescriptionUnit of Service
180LOA Hospital less than 85% occupancy – Traditional Style Bed or ICF/IID1 Day
183LOA – Home – Traditional Style Bed or ICF/IID1 Day
185LOA Hospital 85% or greater occupancy – Traditional Style Bed or ICF/IID1 Day
189LOA No Pay – Traditional Style Bed or ICF/IID1 Day
190Skilled Nursing – Traditional Style Bed1 Day
191Intermediate I – Traditional Style Bed1 Day
192Intermediate II – Traditional Style Bed1 Day
193Intermediate III – Traditional Style Bed1 Day
194ICF/IID1 Day
658Hospice Room and Board – Traditional Style Bed or ICF/IID1 Day

2. Homestyle rates for Homestyle NH services
    (below is a list of valid Homestyle Revenue Codes)

Revenue CodeDescriptionUnit of Service
184LOA HOME – Home Style Facility1 Day
186LOA Hospital 85% or Greater Occupancy – Home Style Facility1 Day
187LOA Hospital Less than 85% Occupancy – Home Style Facility1 Day
188LOA No Pay – Home Style Facility1 Day
199Home Style Facility All LOC1 Day
659Hospice Room and Board – Home Style Bed1 Day

NET Providers

Change Description
NET EDI –
X12 Field BHT06
If you use a billing vendor, your encounters may be misinterpreted in the new system causing them to DENY unless X12 field “BHT06” has the value “RP.”

In the legacy MMIS, encounters processed with a value of “CH” in this field; however, this value will may cause a denial in the new MMIS. Please make certain your billing vendor knows the BHT06 field values:
  • RP = Report encounter
  • CH = Claim for payment
The legacy system translator did not consider field BHT06 when accepting claims. The new MMIS translator DOES consider field BHT06. This issue MUST be addressed or your encounters will be marked as claims for payment.

Nurse Practitioner Providers

Change Description
Z Code Conversion Z codes are being crosswalked to national codes where necessary.
View policy changes related to Z codes crosswalked to national codes. (PDF, new window)

Physician Providers

Change Description
Z Code Conversion Z codes are being crosswalked to national codes where necessary.
View policy changes related to Z codes crosswalked to national codes. (PDF, new window)

Prosthetic Providers

Change Description
Z Code Conversion Z codes are being crosswalked to national codes where necessary.
View policy changes related to Z codes crosswalked to national codes. (PDF, new window)

Rehabilitative Hospital Providers

Change Description
Z Code Conversion Z codes are being crosswalked to national codes where necessary.
View policy changes related to Z codes crosswalked to national codes. (PDF, new window)

Rehabilitative Services for Persons with Mental Illness (RSPMI) Providers

Change Description
RSPMI EDI
X12 Field BHT06
If you use a billing vendor, your claims may be misinterpreted in the new system causing them to DENY unless X12 field “BHT06” has the value “CH.”

In the legacy MMIS, some claims have processed with a value of “RP” in this field; however, this value will cause a denial in the new MMIS.

Please make certain your billing vendor knows the BHT06 field values:
  • RP = Report encounter
  • CH = Claim for payment
The legacy system translator does not consider field BHT06 when accepting claims. The new MMIS translator DOES consider field BHT06. This issue MUST be addressed immediately or your claims will be marked as encounters and will NOT PAY.

Rehabilitative Services for Youth and Children Providers

Change Description
Z Code Conversion Z codes are being crosswalked to national codes where necessary.
View policy changes related to Z codes crosswalked to national codes. (PDF, new window)

Trading Partners

Change Description
837D - EDI – Rendering Provider 837D EDI claims are now required to send NPI and Taxonomy in the Rendering Provider loop 2420A.
837P - EDINPI Editing 837P EDI claims loop 2420A NPI check digit editing performed.
RSPMI EDI –
X12 Field BHT06
If you use a billing vendor, your claims may be misinterpreted in the new system causing them to DENY unless X12 field “BHT06” has the value “CH.”

In the legacy MMIS, some claims have processed with a value of “RP” in this field; however, this value will cause a denial in the new MMIS.

Please make certain your billing vendor knows the BHT06 field values:
  • RP = Report encounter
  • CH = Claim for payment
The legacy system translator does not consider field BHT06 when accepting claims. The new MMIS translator DOES consider field BHT06. This issue MUST be addressed immediately or your claims will be marked as encounters and will NOT PAY.

Go to Arkansas Medicaid         dxc.technology

© 2018 DXC Technology