What’s New for Arkansas Medicaid Providers
Content updated November 15, 2019
Beginning on November 7, 2019, Medicaid will turn on two new edits in interChange to ensure Medicare crossover claims are paid in accordance with current federal and state policy. Edit 559 will now post when the coninsurance amount is greater than the paid amount. Edit 565 will post when the coinsurance and/or deductible amount is greater than the billed amount. To ensure accurate billing and payment for claims that do not cross over from the Medicare Coordination of Benefits Agreement (COBA) process, you will need to enter information for each service provided on the detail lines of the claim you submit through interChange. Failure to do this will result in the above edits posting and denial of the claim. For more information on how to bill crossover claims, please see Section 332.100 in your Medicaid provider manual.(Word, new window)
DXC Technology’s Medicaid software, Provider Electronic Solutions
(PES), enables health care providers to verify
beneficiary eligibility, request prior authorizations, and submit claims
electronically. However, because PES software is no longer supported, providers who use PES are strongly encouraged to transition to the Arkansas Medicaid HealthCare Provider Portal before their software becomes obsolete.
Get the facts about the transition now.
Currently any professional claims billing a bilateral prosthetic device with one line and two units will get paid for both units. Beginning September 13, 2019, any professional claims billing a bilateral prosthetic device with one line and two units will cutback to one unit and deny the remaining units. The first anatomical modifier on the claim will be the one recognized as paid. To be paid for both devices, providers will either need to bill a new claim with the second anatomical modifier and 1 unit or bill their claim with two lines, each line having one of the anatomical modifiers and one unit.
CMS has established guidelines allowing providers enrolled in Medicare and Medicaid to be revalidated through a streamlined process. In order to qualify, provider information on file with Arkansas Medicaid must match the information in Medicare’s Provider Enrollment, Chain, and Ownership System (PECOS).
Medicaid Provider Enrollment will begin checking PECOS for providers who must revalidate soon. If Provider Enrollment confirms a match between the two systems, revalidation will be processed with no further provider action necessary. To take advantage of this time-saving opportunity, Enrollment encourages providers to keep these important match criteria updated with Arkansas Medicaid and PECOS:
If Enrollment is unable to confirm a match between the two systems, the provider will receive a revalidation letter and be required to submit a full enrollment application to revalidate their enrollment as an Arkansas Medicaid provider.
Arkansas Medicaid released an RA message to Developmental Rehabilitation Services providers.
View the RA message regarding Reimbursement Rate for 96113. (Word, new window)
Arkansas Medicaid released an RA message to all providers.
View the RA message regarding Crossover Claims. (Word, new window)