Frequently Asked Questions
For your convenience, we’ve answered the questions we’re asked most often. If you have a question about Arkansas Medicaid that isn’t answered here, please get in touch with us (Word, new window). Need help finding information on the website? Contact the webmaster with your web-related questions.
Billing Policy Questions
Electronic Data Interchange (EDI) Questions
HealthCare Provider Portal Questions
Prescription Drug Questions
Prior Authorization Questions
What services are covered by Arkansas Medicaid?
Medicaid pays for a wide range of medical services. The Division of County Operations (DCO) (HTML, new window) assists in determining if Medicaid pays for a specific service. Many benefits have limits, especially for adults, which may be daily, weekly, monthly or annually. There are also services that have an overall dollar amount limit per time period. Some services require a referral from the beneficiaries’ PCPs. Services may be rendered by both private and public providers. All services, by definition or regulation, fall into one of the following groups:
NOTE: In addition to the services shown in these groups, the State complies with federal requirements regulating the EPSDT program. “Early and periodic screening and diagnosis and treatment” means:
- Screening and diagnostic services to determine physical or mental defects in beneficiaries under age 21; and
- Health care, treatment, and other measures to correct or ameliorate any defects and chronic conditions discovered.
Where can I see changes to policy and other provider-related notifications?
As new information is issued, provider bulletins and notifications are posted on What’s new for Arkansas Medicaid Providers along with manual updates, official notices and RA messages. Be sure to check this page often for important provider-related information and policy changes.
In accordance with federal and state law, the Division of Medical Services must advertise and make available for public comment proposed new and amended rules and other documents, such as certain initial waiver requests and waiver renewals. (See Proposed Rules for Public Comment.) DMS must also notify the public of its intent to hold public hearings and make available a public comment period. (See Upcoming Public Hearings.)
Whom can I call with a question about a claim?
Call the Provider Assistance Center at one of the following numbers:
Local and out-of-state:
When is the cutoff for claim submission?
Claims must be submitted by 6:00 p.m. each Friday in order to be included in the weekly financial cycle. Your claims must be included in the financial cycle to pay the following week.
For Pharmacy claims processed by Magellan, the claims submission cutoff is midnight each Thursday.
How can I check my claims’ status?
You can check claim status using the Search Claims option on the HealthCare Provider Portal or with the Voice Response System (VRS). View or print the Job Aid for how to check claim status on the HealthCare Provider Portal. (PDF, new window)
Additionally, you can see the individual claim results on your 835 Electronic Remittance Advice(s), which are produced weekly as they have been in the past.
For EDI X-12 submitters: Trading Partners must select the 276 transaction set in order to receive the claim status response. The Unsolicited 277 Response is no longer be available. To get a 277 Response, you must have a 276 Transaction.The MMIS responds to a 276 Claim Status Inquiry with a 277 Claim Status Response(s). You will also be able to view your adjudicated claim using the HealthCare Provider Portal; or after the financial cycle each week, you can locate it on your Remittance Advice.
For PES users: The 277 Claim Status Response(s) report is no longer available in PES 2.25.
Use the HealthCare Provider Portal, your Remittance Advice or the Voice Response System (VRS) to check claims status.
Was my claim denied?
The HealthCare Provider Portal adjudicates your claims shortly after they are received and tells if your claim will pay, suspend or deny. If a claim is denied, the system will show the reason under Adjudication Errors.
What if I find a mistake in my claim?
If you realize that a claim contained an error, the error is corrected with an edit, void or adjustment. Electronic adjustments completed on the HealthCare Provider Portal are preferred. Recorded webinars for correctly submitting both institutional claims and professional claims are available to assist you.
Submitting and Reviewing Institutional Claim Forms (HMTL, new window)
Submitting and Reviewing Professional Claim Forms (HMTL, new window)
If you submit an adjustment request on paper, the HP-AR-004 Adjustment Request (PDF, new window), along with your updated claim must but be submitted to DXC Technology. In the “Description” area of the Adjustment Request Form, note “Corrected claim is attached.”
Will refunding incorrectly paid claims fix my billing mistake?
No. To correct claims that have paid incorrectly due to other insurance payment, please void or adjust the claim using the HealthCare Provider Portal or 837 process and rebill with the correct payment information. Sending a refund to correct overpayment does not update the claim data required for your documentation.
When voiding a claim through the HealthCare Provider Portal, can I resubmit a new claim right away, or do I have to wait until the voided claim processes on the upcoming remit to submit the new claim?
Yes, you should be able to void the claim and resubmit the new claim the same day.
If a patient has both Medicare and Medicaid coverage, how do I file the claim?
Bill Medicare first. Then,
If the patient has only Medicare and Medicaid coverage and Medicare pays part of the claim (or applies the charge toward the deductible), bill the balance as a “crossover” claim through the HealthCare Provider Portal.
- Log onto the portal.
- click the Claims tab.
- Select the Institutional or Professional claim form needed.
- Select Crossover Institutional or Crossover Professional in Claim Type.
You can submit a crossover claim on paper, but the proprietary crossover claim forms can no longer be used. Providers submitting paper crossover claims will use either CMS-1500 or CMS-1450 (UB04) along with DMS-600 – Medicare EOMB Information (PDF, new window), found in Section V of your billing manual.Submit paper crossover claims to:
PO Box 34440
LITTLE ROCK AR 72203
- If the patient has only Medicare and Medicaid coverage and Medicare denies the claim, bill the charges to Medicaid on an original red-ink claim for (CMS-1500 or CMS-1450), attaching the Medicare denial. Submit the claim to:
PO BOX 8036
LITTLE ROCK AR 72203
- If Medicare denies the claim and the patient also has Medicare-supplement or private insurance, bill the charges to Medicaid on an original red-ink claim form (CMS-1500 or CMS-1450), attaching both the Medicare denial and the insurance company’s Explanation of Benefits form. Submit the claim to the DXC Technology research analyst as shown above.
- If Medicare pays the claim but Medicare-supplement or private insurance denies it, bill the claim to Arkansas Medicaid on the paper crossover invoice, attaching the insurance company’s denial. Submit the claim to the DXC Technology research analyst as shown above.
- If both Medicare and Medicare-supplement or private insurance deny the claim, then bill the charges to Medicaid on an original red-ink claim form (CMS-1500 or CMS-1450), attaching both denials. Submit the claim to the DXC Technology research analyst as shown above.
How are crossover claims priced and paid?
Inpatient Crossover Claims
MMIS prices and pays the difference between the Medicaid Allowed amount and the Medicare Paid amount, up to but not exceeding the coinsurance plus deductible amount. Crossover claims will post an EOB 9915 – Pricing Adjustment – Medicare crossover claim cutback applied when the amount paid is adjusted to not exceed the coinsurance plus deductible amount.
Professional and Outpatient Crossover Claims
Professional and Outpatient crossover claims are priced and pay coinsurance plus deductible.
What do you mean that this procedure is “incidental?”
Arkansas Medicaid considers the procedure to be part of another procedure for which a claim has already been filed. This item cannot be billed separately.
Why won’t Medicaid pay for an office visit and urinalysis?
Arkansas Medicaid considers urinalysis to be “incidental to” (a part of) the office visit.
This claim was denied for “timely filing.” What does that mean?
Arkansas Medicaid pays claims that are received within 12 months of the date of service.
Where can I get Medicaid forms I need?
Most forms are available in Section V of your billing manual. View Section V to obtain available forms. (Word, new window) Official billing forms that are accepted by Arkansas Medicaid include a barcode and a MICR line.
The Medicaid Program does not provide copies of the CMS-1500 claim form. The provider may request a supply of this claim form from any available vendor. View a CMS-1500 sample form. (PDF, new window)
The Medicaid Program does not provide copies of the CMS-1450 claim form. The provider may request a copy of this claim form from any available vendor. View a CMS-1450 (UB-04) sample form. (Word, new window)
An available vendor is the U.S. Government Printing Office. Orders may be submitted to the U.S. Government Printing Office via phone, fax, letter, e-mail or the Internet. View or print the U.S. Government Printing Office contact information. (Word, new window) The Arkansas Medicaid fiscal agent requires the use of red-ink (sensor coded) CMS-1500 claim originals instead of copies. The processing system uses scanners to distinguish between red ink of the form fields and blue or black ink claim data (provider identification number, procedure codes, etc.).
Where can I get help completing a CMS-1500 claim form?
Detailed billing instructions for your provider type can be found under “Billing Procedures” in Section II of your provider manual. Electronic claim submission is preferred; however, you may find the field descriptions in the paper billing instruction helpful.
Which benefiary ID should I use to search for claims?
If you are doing a claim search in the HealthCare Provider Portal or through the Voice Response, you must use the most current Medicaid beneficiary ID number. If you are not certain that you have the current beneficiary ID number or you cannot locate a claim you know has been accepted, denied or suspended, then verify eligibility using the beneficiary’s name and date of birth. This search method will allow you to find the beneficiary’s most current ID number. You can then perform the claim search using the most current beneficiary Medicaid ID number.
How can I search for legacy MMIS claims in the HealthCare Provider Portal?
With the implementation of the new Arkansas MMIS claim-processing system, seven years of information on claims processed in Legacy MMIS were converted to the new Arkansas MMIS. Providers can access information on past claims through the HealthCare Provider Portal. When logged into the Portal, delegates who have been assigned the Claim Inquiry function can navigate to Claims, select Search Criteria, and enter the relevant information to search for a claim.
Although claim information will be available in the HealthCare Provider Portal, claims processed in Legacy MMIS that were converted to the new Arkansas MMIS will have new claim identification numbers (Claim IDs); the internal control numbers (ICNs) assigned by Legacy MMIS will not be used. Providers will not be able to search for claims processed in Legacy MMIS using the old ICNs. Other search criteria will be required to retrieve claim information. After a claim is identified in the new system, providers are encouraged to record the new Claim ID, as needed, for later reference. Use search criteria such as Beneficiary ID, Service ‘From and To’ and Claim Type in the HealthCare Provider Portal to find claims processed in Legacy MMIS that have been converted into the new Arkansas MMIS. Remember to use the most current ICN for the claim when requesting and adjustment or performing and inquiry.
Can I use my license number on institutional claims?
No. When submitting provider identification numbers in fields such as attending, operating, or facility ID, on an 837I electronic transaction providers must enter the NPI rather than a license number. For paper claims, the NPI or Medicaid Provider ID is acceptable but not a license number. If the claim is submitted with a license number in any of the provider ID fields as noted above the claim will be denied.
Note: The billing ID must always be an NPI on all institutional claims.
Can I submit multiple dates of services on one claim submission if the CPT and diagnosis codes are the same for a beneficiary?
Yes. You can submit up to 200 lines for Dental and Professional and 999 lines for Institutional.
Where do I enter the facility ID for hospice claims when a beneficiary is in a long term care facility?
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.
Which beneficiary ID?
If the beneficiary’s eligibility for Medicaid services has not been continuous, then that beneficiary may have more than one ID on record. Beneficiary IDs have been linked to a single “active” ID; if you use an old ID on a claim, for example, the active ID will appear on your remittance advice. If this happens, you should start using the ID shown on your remitttance advice.
How many digits are in a beneficiary’s ID number?
I have questions about electronic billing. Is there someone I can talk to?
If you have questions or problems related to electronic claims, call the EDI Support Center.
Local and out-of-state:
Please note: If you need assistance installing PES on your network or resolving transmission problems when using PES on your network, you will need to contact the technical support representative or team in your office. EDI does not support network issues.
Providers who file electronic claims can report “Host Processing Error,” “Unable to Assign ICN” or “Server is Down” messages during off hours by calling the EDI Help Desk at (501) 374-6609, ext. 290. This number is available Monday through Friday, 6 pm to 6 am, and on weekends and holidays. Leave a message, and Help Desk personnel will be paged immediately. If you do not leave a message, no problem report will be registered. Do not use this number to report claim rejections.
What are the system requirements to use the HealthCare Provider Portal?
Providers with PCs can submit claims via the web using an internet browser. To ensure the best possible user experience while visiting the HealthCare Provider Portal, we recommend using Microsoft Internet Explorer version 7.0 and later, Mozilla Firefox, Google Chrome or Safari with a minimum screen resolution of 1024 x 768 pixels. The web-based portal was designed to integrate seamlessly with the Arkansas Medicaid Management Information System (MMIS) and is therefore the preferred method for electronic transactions.
Access the Arkansas Medicaid Provider Portal. (HTML, new window)
Job Aids are available to help with submitting claims (PDF, new window) and verifying eligibility (PDF, new window) via the portal.
How can I find my RAs?
You can find RAs on the HealthCare Provider Portal (HTML, new window).
View or print the Search Payment History job aid to help you find your RA. (PDF, new window)
When searching for RAs on the HealthCare Provider Portal, providers should enter the Monday through Friday date range for that week’s RA. The HealthCare Provider Portal uses the issuance date to locate the RA.
How long will my RA be available on the HealthCare Provider Portal?
A provider’s Remittance Advices will be available on the HealthCare Provider Portal for up to 7 years beginning November 1, 2017 going forward.
What kind of file is the Remittance Advice on the claim search?
The RA is in portable document format (.PDF).
What electronic and digital signatures will Arkansas Medicaid accept?
Medicaid will accept electronic signatures provided the electronic signatures comply with Arkansas Code § 25-31-103 et seq.
What is the billed-threshold amount?
The maximum amount billed is $9,999,999.99 per line.
Where do I upload batch files created in facility-specific billing software?
Providers will need to contact the EDI Support Center for information concerning uploading batch files. Contact EDI at 1-800-457-4454.
If we are filing a batch of claims on the HealthCare Provider Portal, do we have to switch providers to match who we are filing the claim under?
You will need to contact the EDI Support Center at 1-800-457-4454 for instructions on this process.
Am I required to include a Patient Control Number on 276 transactions?
No, a patient control number is not required. However, if you are submitting a patient control number on 276 transactions, you must send the REF segment with a qualifier of “EJ” along with the patient control number. If you do not wish to indicate a patient control number, then you need to leave off this segment from your transaction. The REF segment with the patient control number is not a mandatory or required segment. However, if you send the REF segment with REF01=EJ and you leave off patient control number in REF02, this will cause a compliance error. Please get with your software vendor to ensure you are doing this correctly.
Is this patient eligible to receive Medicaid benefits?
The HealthCare Provider Portal (HTML, new window) is the preferred method to verify the patient’s eligibility. (View or print the Eligibility Verification Job Aid. (PDF, new window)) Beneficiary eligibility is determined by the local DHS offices and can be started or stopped anytime the beneficiary’s situation changes. Having a Medicaid ID card is not proof of eligibility and the responsibility of checking a beneficiary’s eligibility to receive Medicaid services lies with the Medicaid provider.
Can I check a prior eligibility date?
Yes, you can check previous dates back to one year. You cannot check for future eligibility dates.
When checking eligibility for today, will the results show that the member is inactive, and will it give the term date?
The HealthCare Provider Portal will show the effective date and end date if the coverage has termed. If the coverage is current, it will supply them with the effective date. However, it will not list the end date for a current plan in the HealthCare Provider Portal.
Will eligibility treatment history show the last well child exam/Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) or is it under eligibility verification?
This information will be visible on the Eligibility Verification.
Will Third-Party Liability (TPL) add the other health insurance (OHI) to the eligibility strip once entered on a keyed claim? Alternatively, do we still need to call TPL?
Yes. The TPL department with verify the other health insurance that was entered on a claim. Once verified, this information will be available on the Eligibility Search page under the Other Insurance hyperlink. It will no longer be necessary to call the TPL department.
How can I become an Arkansas Medicaid provider?
To learn more about enrolling as an Arkansas Medicaid provider, see Provider Enrollment Information..
If you have questions about how to enroll, call Arkansas Medicaid Provider Enrollment at (501) 376-2211 (local or out of state) or (800) 457-4454 (Arkansas). When prompted, select 0 for “Other Inquiries”, then option 3 for “Provider Enrollment”. View or print Provider Enrollment contact information (Word, new window).
If you are required to have a National Provider Identifier (NPI), you must report it to Arkansas Medicaid once enrolled as an Arkansas Medicaid provider. For more information about the NPI, view NPI frequently asked questions.
I need a replacement 1099. What should I do?
If your paper 1099 form mailed from Arkansas Medicaid has been lost or misplaced, you have 90 days (from issue on January 31) to print a replacement from the HealthCare Provider Portal. To access your 1099, select “Financial 1099 History” under Category for File Download. Enter 01/01/YYYY (year of 1099 needed) as the From Date and 03/01/YYYY as the To Date. Each 1099 file will start with characters LOD.FIN.TX07 at the beginning of the file name. These 1099 documents are generated by provider number. To know what information was reported to the IRS, you will need to get ALL 1099s for each provider number reported under your tax ID number.
After the 90 day period ends in April, you must contact the Provider Assistance Center for help retrieving your 1099.
What is deferred compensation?
As a Medicaid provider, you are an independent contractor of the state of Arkansas and are eligible to defer a portion of your Medicaid income on a pre-tax basis. By making contributions to the State of Arkansas Diamond Deferred Compensation 457(b) Plan, commonly referred to as the Arkansas Diamond Plan, you can include Medicaid as an element of your retirement planning.
The annual dollar limit is $18,500 for calendar year 2018. If you are age 50 or older, the catch-up contribution annual dollar limit is $6,000 for calendar year 2018. This deferral is in addition to any contributions made on your behalf to a qualified retirement plan established by your group or individual practice such as a 401 (k) plan, a profit sharing plan, a money purchase pension plan or a defined benefit plan. The Arkansas Diamond Plan includes a special pre-retirement catch-up provision which allows deferrals for three consecutive years. The Arkansas Diamond Plan also offers a ROTH option. Participants can utilize both options during the year if they wish, but their total contribution cannot exceed their respective calendar year limit.
For more information regarding the Plan, eligibility requirements, and investment options, contact Robert Jones of Stephens, Inc. at 501-377-8112 or 1-866-275-0457.
How can I change my PCP caseload?
Providers can change their patient caseloads on the HealthCare Provider Portal. If the PCP caseload is set over 2500 using the online form, an error will be reported and no change will be made. If you would like to set the PCP caseload over 2500, Provider Enrollment requires a written request stating why the higher caseload is needed. The request should be attached online.
How can I change my demographic information?
Demographic information can be viewed after you have logged onto the HealthCare Provider Portal under Characteristics. You must call enrollment to update this information, however. This is a security feature for your protection.
Why can’t I access the HealthCare Provider Portal?
Only currently active providers have access to the HealthCare Provider Portal. Inactive or suspended providers must contact the Provider Enrollment Unit before they will be able to log on the portal. You must register to begin using the HealthCare Provider Portal. Job Aids are available to assist with provider registration (PDF, new window) and delegate registration (PDF, new window) for the portal.
HIPAA requirements mandate the following security measures for the HealthCare Provider Portal:
- Users will be automatically directed to change their password if it matches their Tax ID/SSN or Medicaid provider ID.
- Passwords must meet all of the password requirements for the HealthCare Provider Portal.
- Users must select a security question and provide an answer to that question to be used later to unlock the account or recover a password.
- Security question answers must:
- Be at least 4 characters long
- NOT contain the user ID
- NOT contain the security question
- Users will be redirected to the log-on page if there is no activity on a secure page for more than 20 minutes.
- Users will be locked out of an account automatically after six failed log in attempts within an hour.
What are the requirements for passwords on the HealthCare Provider Portal?
Passwords for the HealthCare Provider Portal must adhere to specific requirements. All passwords are case sensitive and must:
- Be between 8 and 20 characters in length
- Contain at least 1 alpha character
- Contain at least 1 numeric character
- Contain at least 1 uppercase character
- Contain at least 1 lowercase character
- Contain at least 1 special character
- NOT contain the same character more than twice
- NOT contain the user ID
- NOT be any of the previous 6 passwords
If I forget my security question(s) for the HealthCare Provider Portal, who should I call?
You will need to contact the EDI Support Center at 800-457-4454.
What’s the difference between “enrolling” and “registering?”
Enroll – Obtain an 8-digit Trading Partner ID required to submit claims in the
Trading Partners – Clearinghouses, billing services or software companies — “Trading Partners” — will enroll to obtain a Trading Partner ID.
Register – Gain access to the HealthCare Provider Portal by getting your unique username and password.
Portal Submitters will register to access the HealthCare Provider Portal to submit claims.
If I am a provider, do I need to enroll for a Trading Partner ID?
Medicaid providers who answer YES to any of the following must enroll for a Trading Partner ID to view details of their capitated fee information (formerly managed care fees in the legacy MMIS):
- Will use PES
- Will use EDI direct submission
- Will upload information into the HealthCare Provider Portal
- Will receive capitated fee information (formerly managed care fees in the legacy MMIS) related to any of the following programs:
- Arkansas Works (formerly called Private Option)
- Assisted Living
- Comprehensive Primary Care (CPC)
- Long-Term Care Adjusted Service Fee Claims
- Non-Emergency Transportation (NET) Service Fee Claims
- Programs for All-Inclusive Care for the Elderly (PACE)
- Patient-Centered Medical Home (PCMH)
- Primary Care Physicians (PCP)
Should I enroll as a Trading Partner?
Clearinghouses, billing services and software companies are referred to as “Trading Partners.” If you are a clearinghouse, billing service or software company, you MUST enroll to obtain your Trading Partner ID in order to submit claims in the
Do I need to register for the HealthCare Provider Portal?
Both Providers and Trading Partners are required to register on the HealthCare Provider Portal. It is possible that you must register as both a provider AND a Trading Partner.
Can I verify that my Trading Partner ID is active?
When a Trading Partner enrolls for a new ID, there is a delay of up to five days before the Trading Partner ID is activated in the new MMIS. This delay enables staff to certify the trading partner’s file processing and ensure activation in multiple applications that support EDI file processing (standard HIPAA-compliant transaction files).
Trading Partner Status can be verified on the new HealthCare Provider Portal (HTML, new window). You will see the question “Would you like to enroll as a Provider or a Trading Partner?” to the left of the portal webpage. Click Trading Partner, then click Trading Partner Enrollment Status. Enter your Trading Partner ID and click Search. The information returned provides the status of the Trading Partner ID. If the Trading Partner Status is listed as “Currently Active,” you may submit your standard EDI HIPAA transaction files.
Will the diagnosis dropdown menu prepopulate the full six-digit ICD-10 code?
As you type the diagnosis code, the HealthCare Provider Portal will begin to prepopulate the diagnosis code allowing you to choose the desired code.
Does the HealthCare Provider Portal alert me when a procedure requires prior authorization?
Providers will have to refer to the provider manual to determine if a code requires a prior authorization. The HealthCare Provider Portal does not provide this information.
Will the Provider Search option show the physician’s provider number?
No. The Provider Search tab will give you the name and address of the provider. In order to obtain more information, you will need to contact the provider.
Where can I find specific benefits for a patient and their benefit limit?
In order to search for benefit limits, click on Eligibility Verification under the Eligibility tab and fill out the service type or procedure code section to get results on a beneficiary’s benefit limits. The Treatment History link will only give information on the services that were performed by your provider.
Is there somewhere on the HealthCare Provider Portal to check how many visits a patient has completed?
Yes. If the provider searches under Treatment History, information on the services they provided for that beneficiary is given. If they want to know how many visits are used, they will need to search under the Eligibility Verification tab and enter the service type code or procedure code. The HealthCare Provider Portal will give information on how many visits are used. However, the Eligibility Verification tab will not tell which provider was paid.
How do I link my X12 transactions (820, 834, 835) to a particular trading partner?
You can link your trading partner ID on the HealthCare Provider Portal. Learn how to link your trading partner ID. (PDF, new window)
Will delegates be able to electronically assign Primary Care Physicians (PCPs) for beneficiaries?
No, providers and/or delegates cannot assign PCPs. A PCP can be assigned by:
- Calling the ConnectCare Help Line at 1-800-275-1131
- Completing the PCP choice on a “Primary Care Physician Selection and Change” form (DMS 2609 or DCO-2609.)
- Calling the Voice Response System 1-800-805-1512.
Where may I see a list of the drugs covered by the Arkansas Medicaid program?
Arkansas Medicaid provides guidelines for determining what products are payable. Coverage of any product depends on the manufacturer’s or labeler’s participation in the federal rebate program administered by the Centers for Medicare and Medicaid Services. The Arkansas Medicaid Pharmacy provider manual defines the scope of coverage in Section II. View or print the Pharmacy provider manual.
More prescription drug information can be found at the Magellan Medicaid Administration website (HTML, new window).
Whom should I call for prior authorizations (PAs)?
Where you obtain PAs depends both on the type of PA and the beneficiary’s age. You will find contact information for each type of PA on the HealthCare Provider Portal (log on, select the Care Management tab and then Authorizations.)
Some PAs can be requested through the HealthCare Provider Portal (log on and select Care Management), while others are processed through Medicaid contractors such as AFMC or Beacon Health Options. If you request your PA type through Beacon Health or AFMC, use the instruction in Section II of your provider billing manual for requesting PAs.
The HealthCare Provider Portal requires 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.
The following PA types are available on the 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
On a prior authorization for sedation, can Dental providers enter the day before on the “from” date?
Yes, the provider can request dates in the past.