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Your Information Hub for the New MMIS

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

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Page Contents

Our Provider Assistance Center and EDI Support Center are open from 6:00 a.m. to 6:00 p.m. Monday through Friday. EDI, PAC, Provider Enrollment, and AIPT share the same convenient phone numbers:
(800) 457-4454 in-state toll-free or
(501) 376-2211 local and out-of-state.

If you need to call the EDI Support Center for assistance, please have the person most familiar with the electronic billing and expected responses call with the following information to expedite research:

  • Your provider number(s)
  • Your trading partner number(s)
  • Your method of submission – HealthCare Provider Portal, PES, upload via the portal or secure website, vendor system/billing company/clearinghouse

Immediate Notifications

Notifications at a Glance

Electronic Funds Transfer – Action Required for Pharmacy Providers
Fingerprint Requirement for High Risk Providers
Replacement 1099s
Prior Authorization Requests
Approvals from MCOs
Refunds
Professional Claims that Span Multiple Dates of Service
Billing Medicaid for Services Not Covered By Other Insurance
NET Providers using Billing Vendors (NET EDI – X12 Field BHT06)
ARChoices Waiver Services Provided on Day of Admission to Institution
How to Link Your Trading Partner ID
Crossover Claims Pricing Update
Dental Prior Authorization Request Transition
Patient Control Number – 276 Transaction
Claim Submission Cutoff
MC IDs/Old Submitter IDs
Hospice in Long Term Care Claims
Locating Your New Remittance Advices
Institutional Providers – Using NPI and Medicaid Provider ID Rather Than License Number
Searching for Legacy MMIS claims in the HealthCare Provider Portal
Processing Time Between Trading Partner ID Enrollment and EDI Submission
Claim Search
PES Submitters Acknowledgement
RSPMI Providers using Billing Vendors (RSPMI EDI – X12 Field BHT06)
Trading Partner – Referring Provider Update

Electronic Funds Transfer – Action Required for Pharmacy Providers

Added 10/16/18
All providers have been notified that Arkansas Medicaid will no longer produce and mail paper checks. Providers must now utilize electronic fund transfer (EFT), which allows your Medicaid payments to be directly deposited into your bank account. If you already receive your Medicaid payments by EFT, then no further action is required.

If you DO NOT receive EFT payments for Medicaid services you provide, you must take action NOW to ensure that you continue to receive Medicaid payments.

Complete the Electronic Fund (EFT) Authorization for Automatic Deposit (Word, new window), located in Section V of your provider manual.

Return the completed EFT authorization form along with a voided check or letter from your bank reflecting the bank’s ABA number and your account number before 12/31/2018 to:

Medicaid Provider Enrollment Unit
DXC Technology
P.O. Box 8105
Little Rock, AR 72203-8105

or

Arkansas Medicaid Pharmacy
Fax-800-424-5851

If you do not take action by December 31, 2018, your provider number will be suspended until the EFT information is received.

Fingerprint Requirement for High Risk Providers

Added 10/2/18
Federal fingerprint-based background checks are required for all high risk providers (and their owners who have a 5% or greater direct or indirect ownership interest) as a condition of enrollment in the Arkansas Medicaid program. In addition, high risk providers will be required to re-enroll/revalidate their enrollment with Arkansas Medicaid every three years.

If you are identified as a high risk provider, you will be notified by mail. Failure to comply within sixty days of the date on this letter will result in termination from the Arkansas Medicaid program. Providers will be responsible for any fees associated with processing the fingerprint application.

There are two options available to process your fingerprints—the ink-based fingerprint card or electronic fingerprints. Detailed instruction for each method is included in the letter. Inform the vendor the reason fingerprinted is “6401 Medicaid.”

For electronic fingerprinting, each applicant must choose and contact an approved vendor to capture electronic fingerprints. The location will electronically submit the fingerprint form. Approved electronic fingerprinting vendors are Arkansas Live Scan or Hixson Adventure, Fitness & Tactical Academy (HAFTA).

For ink-based fingerprinting, you must use the fingerprint card provided by the Division of Medical Services. (ORI Number ARPAC000Z) To obtain a fingerprint card, call (501) 537-1257 to have one mailed to you. The card must be legibly completed or processing will be delayed. Fingerprints must be taken by properly trained personnel. Your local police department or sheriff’s office may provide this service; however, you must provide a 9x12 brown mailing envelope to mail your fingerprint card and pay any associated fees. The Arkansas State Police ID Bureau collects fingerprints, without charge, Monday through Friday, 8:00 a.m. until 4:30 p.m.

You may elect to challenge the accuracy of the criminal history record information by contacting the appropriate agency.

Replacement 1099s

Updated 7/27/18
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.

Prior Authorization Requests

Updated 7/2/18
Prior authorizations requests that should go to AFMC are being incorrectly entered into the HealthCare Provider Portal. These requests will not be processed through the portal and MUST go to AFMC for processing as usual. 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

Approvals from MCOs

Added 5/21/18
Arkansas Medicaid will honor approvals from Delta Dental or Managed Care of North America (MCNA) for beneficiaries deemed ineligible because they are residents in a Human Development Center, nursing home setting or are in the Program for All Inclusive Care for the Elderly (PACE). Enrolled Arkansas Medicaid providers must submit a copy of the approval from the managed care organization along with an ADA claim form detailing services rendered. To submit the claim electronically through the HealthCare Provider Portal, providers should first enter their PA request. Once the PA is approved, the claim and attachments can be submitted electronically.

When submitting on paper, please mail to:
DHS Division of Medical Services
Dental Care Unit
P.O. Box 1437, Slot S410
Little Rock, AR 72203-1437

Refunds

Added 5/18/18
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.

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.

NET Providers using Billing Vendors (NET EDI – X12 Field BHT06)

Added 3/7/18
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.

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

How to Link Your Trading Partner ID

Updated 1/17/18
You can now link your trading partner ID on the HealthCare Provider Portal. View or print the new job aid to learn how to link your trading partner ID. (PDF, new window)

Crossover Claims Pricing Update

Updated 1/11/18
Inpatient Crossover Claims
The new MMIS prices and pays inpatient crossover claims a little differently than the legacy system. The legacy MMIS paid coinsurance plus deductible for all crossover claims. The new MMIS 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 still priced and paid according to coinsurance and deductible amounts.

Dental Prior Authorization Request Transition

Added 1/5/18
Dental Prior Authorization (PA) requests with a Date Of Service (DOS) before 12/31/17 must be sent to
Arkansas Department of Human Services Dental Unit
PO Box 1437 Slot S410
Little Rock, AR 72203

Dental PA requests with a DOS on or after 1/1/18 must be submitted to the appropriate Managed Care Organization (MCO).

PA requests will be returned to providers if

  • the requests are submitted to Arkansas Medicaid without the date of service indicated, or
  • the requests cannot be reviewed by 1/22/18 due to high volume of PA requests.

PA requests returned to the provider must be resubmitted to the respective MCO.

Patient Control Number – 276 transaction

Added 12/12/17
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.

Claim Submission Cutoff

Updated 11/30/17
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.

MC IDs/Old Submitter IDs

Added 11/14/17
Many providers have been billing with PES using their old submitter ID (MC ID). You will NOT receive a response from PES if you are using your old submitter ID. Please validate you are using your new Trading Partner ID (TP01#) and not your former Submitter ID (MC0#) in the PES set-up Options Web Logon ID field pictured below:

Hospice in Long Term Care Claims

Added 11/7/17
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.

Locating Your New Remittance Advices

Updated 11/6/17
Are you having trouble finding your RAs on the HealthCare Provider Portal? There's a job aid to help! View or print the Search Payment History job aid. (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. If a provider receives a paper check, then the RA will be issued on a Thursday. If the provider receives EFT, the issuance date for the RA is Friday.

Institutional Providers – Using NPI and Medicaid Provider ID Rather Than License Number

Added 11/3/17
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.

Searching for Legacy MMIS claims in the HealthCare Provider Portal

Added 11/3/17
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.

Processing Time Between Trading Partner ID Enrollment and EDI Submission

Added 10/31/17
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).

Claim Search

Added 10/27/17
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.

PES Submitters Acknowledgement

Added 10/27/17
For submitters using PES, you will receive a 999 functional acknowledgement for all batch submissions.

RSPMI Providers using Billing Vendors
(RSPMI EDI – X12 Field BHT06)

Added 10/27/17
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.

Trading Partner – Referring Provider Update

Added 10/26/17
This information pertains to trading partners – vendors, clearinghouses or billing companies. Providers who are aware of these types of denials should contact and refer their trading partners to this notification.

We are seeing a high HIPAA Compliance X12 failure rate for claims that require the Referring Provider. Both the First Name and the Last Name must be populated; some Trading Partners are leaving one field or the other blank. The following applies:

  • 837I – 2310F loop (Referring Provider First and Last Name must be populated)
  • 837P – 2310A loop (Referring Provider First and Last Name must be populated)
  • The qualifier in NM102 must be a 1 (Person) not a 2 (Organization)

Note 1: The Guides indicate it is supposed to be a person, but we understand that some are actually entities.
Note 2: The text in the fields is NOT examined; therefore, the contents can be whatever the Submitter determines is appropriate.

Ensuring both fields are populated will allow the claims to get past this compliance error. We are updating our Companion Guides to include this information as well.

MMIS Job Aids

Training Materials File Name File Size
Eligibility Verification MMIS_JobAid_Eligibility.pdf 5.4MB
MAPIR MMIS_JobAid_MAPIR.pdf 1.5MB
Prior Authorization MMIS_JobAid_PriorAuthorization.pdf 3.9MB
Registering on the HealthCare Provider Portal – Provider MMIS_JobAid_ProvPortalReg.pdf 6.4MB
Registering on the HealthCare Provider Portal – Delegates MMIS_JobAid_DelegatePortalReg.pdf 4.7MB
Registering on the HealthCare Provider Portal – Trading Partners MMIS_JobAid_TradingPartnerPortalReg.pdf 2.3MB
Frequently Asked Questions Regarding Registering on the HealthCare Provider Portal MMIS_JobAid_PortalRegFAQs.pdf 92k
Trading Partner ID Enrollment MMIS_JobAid_TrdngPrtnrIDEnroll.pdf 1.8MB
How to Link Your Trading Partner ID MMIS_JobAid_LinkTPID.pdf 1.8MB
Frequently Asked Questions for Trading Partner ID Enrollment MMIS_TradingPartnerEnrollFAQ.pdf 98k
Search Payment History MMIS_JobAid_SearchPaymentHistory.pdf 1.2MB
Submitting and Reviewing a Claim MMIS_JobAid_SubmittingReviewingClaim.pdf 3.9MB
How to Check Claim Status MMIS_JobAid_CheckClaimStatus.pdf 1.3MB
Treatment History MMIS_JobAid_TreatmentHistory.pdf 1.8MB
Updating PCP Caseload MMIS_JobAid_UpdatingPCPCaseload.pdf 1.8MB
Uploading Documents MMIS_JobAid_UploadingDocuments.pdf 1.4MB
Using the HealthCare Provider Portal PortalTraining.pdf 15MB

If you would like to learn more about the MMIS, AFMC is hosting a series of webinars. View a webinar today!


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