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Arkansas Medicaid providers and beneficiaries rely on a Medicaid Management Information System (MMIS) for provider enrollment, beneficiary eligibility and claims processing. The success of the new MMIS depends on your satisfaction as an Arkansas Medicaid provider.

Professional Claims that Span Multiple Dates of Service

Added 5/7/18
If you file a professional claim (837P and CMS-1500) with a ‘From and Through’ date span, you must use an ICD-10 diagnosis code that is effective beginning on the ‘FROM’ date of service. If the diagnosis code(s) billed are not valid on the ‘From’ date at the detail line, the detail will deny for 1036 – Diagnosis code not allowed for date of service. To correct a claim with this denial, providers should confirm the correct diagnosis code(s) valid on the From date of service and resubmit with appropriate diagnosis code(s).

This includes all services that allow, or are required per state policy to span a period of dates, such as global obstetrical CPT codes (i.e., 59400, 59510).

Billing Medicaid for Services Not Covered By Other Insurance

Added 3/7/18
If you are a provider of services to a Medicaid eligible Member, but the services you provide are not covered by the Member’s primary insurance company, please see below for documentation and billing guidelines.

  • What documentation do providers need to keep on file as proof they have billed the primary insurance company?
    A provider can use either a certificate of benefits or a denial letter from insurance company (EOB with no payment to provider) or a payment to the provider (EOB with payment). They will need to keep this in the client file for auditing purposes.
  • How long is this denial/EOB good for?
    It will be good for 1 year for either the Certificate of Benefits or Denial EOB.
  • How exactly should this be billed on the claim so that the claim will bypass the TPL editing?
    Example: Get certificate or denial dated 01/01/2018. The provider could use it through 12/31/2018. They would say yes they billed the insurance using a denial date of in this example 01/01/2018 and $0.00 payment amount. Be sure to include Claim Filing Indicator.

ARChoices Waiver Services Provided on Day of Admission to Institution

Added 1/31/18
If ARChoices Waiver services are provided for a beneficiary on the day the beneficiary is admitted to an inpatient facility, the ARChoices Waiver provider can potentially be paid for services which were provided prior to the client's inpatient admission.

The initial billing for payment will not process through Interchange; however, once notification of non-payment is received by the provider, the claim can be re-submitted on paper (red ink claim) along with supporting documentation for special handling. The documentation must contain information verifying the date, time and services that were provided. The documentation must be signed by the person who provided the service(s) and a contact phone number is required so DHS staff can verify verbally, if necessary.

The claim and documentation should be sent to
Division of Provider Services and Quality Assurance
PO Box 1437, Slot S530
Little Rock, AR 72203-1437

Go to Arkansas Medicaid

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