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Arkansas Payment Improvement Initiative
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What’s New for Arkansas Medicaid Providers

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Content updated January 17, 2020

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EIDT and ADDT Claims

Added 1/6/20
Below are changes to EIDT and ADDT billing for claims. These changes are effective for claims with dates of service on or after January 1st, 2020.

  • All EIDT and ADDT services will require place of service 49 (Independent Clinic). In addition to the place of service, the day habilitation unit rate (one unit equals one hour) also increased by 11% for services on or after 01/01/2020.
  • The fee schedules and reimbursement rules will be changing for all nursing EIDT and ADDT services (T1002 and T1003). For EIDT providers, all nursing services are limited to 12 units per date of service, but does allow for extension of benefits.
  • The following services can now be provided by EIDT providers: 96112 with U6 and UC modifiers, 96113 with U6 and UC modifiers. 96112 is limited to 1 unit per state fiscal year, but does allow for extension of benefits. 96113 is limited to 2 units per state fiscal year, but does allow for extension of benefits.
  • The following services can now be provided by ADDT providers: 96112 with U6 and UC modifiers, 96113 with U6 and UC modifiers. 96112 is limited to 1 unit per state fiscal year, but does allow for extension of benefits. 96113 is limited to 2 units per state fiscal year, but does allow for extension of benefits.

Medication Assisted Treatment (ACT 964)

Added 12/31/19
Effective January 1, 2020, Arkansas Medicaid is putting in place measures to comply with Act 964 of 2019, regarding Medication Assisted Treatment (MAT). Pursuant to this Act, Medicaid is removing the prior authorization requirement on the following drugs used to treat opioid use disorder:

  • Suboxone® Film (buprenorphine/naloxone sublingual film)
  • Buprenorphine sublingual tablets

Pursuant to Act 964, in order to receive MAT, a client must have a valid prescription and the treatment must follow the guidelines issued by the Substance Abuse and Mental Health Services Administration (SAMHSA) that are current as of the date of treatment. Medical necessity reviews will be conducted in accordance with the SAMSHA guidelines. To find more information on these guidelines, please visit SAMSHA’s website at https://www.samhsa.gov/medication-assisted-treatment/statutes-regulations-guidelines (HTML, new window).

In an effort to increase access to MAT and compliance with the SAMSHA guidelines, Medicaid will be conducting webinars and working with third party oversight agencies to increase compliance and educate providers on these guidelines.

Change in Use of Modifiers on Claims (Services) Requiring Prior Authorizations

Added 12/30/19
Effective 11/1/19, Prior Authorization (PA) requests are required to include ALL modifiers that will be used or needed on (for) the claim (service). This includes payment impacting, anatomical, and informational modifiers. If the system does not find an exact match on the procedure code/modifier combination, the PA will not be found and the claim (service) will either cut back or deny.

MUMP Prior Authorization Extensions

Added 12/26/19
Beginning 01/29/2020 the process that providers currently use to request additional days on an existing Inpatient Stay Prior Authorization will change. After 01/28/2020 providers will no longer use the PA process Type “Inpatient Extensions” when needing to request additional days be added to an existing PA. The provider will now go to the current approved Inpatient Stay PA and request additional days by adding a line item for the additional days being requested.

Provider Electronic Solutions (PES) Transition

Updated 12/19/19
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 will be decommissioned, providers who use PES are strongly encouraged to transition to the Arkansas Medicaid HealthCare Provider Portal before their software becomes obsolete.

Assessment Dates Available on Portal Eligibility Check

Added 12/5/19
Effective 12/5/19 Behavioral Health Independent Assessment effective dates (both from and to) for PASSE members will be available on the Provider Portal Eligibility check.

Global OB Billing

Updated 12/4/19
All Arkansas OB/Gyn Medicaid Providers:
Below are changes to Global OB Billing for claims. This change becomes effective with claims billed on or after January 1, 2020.

  • The fee schedules and reimbursement rules will remain the same for all Global OB services.
  • A new selection will be added in the drop-down box for “Date Type” called “Initial Treatment Date” in the Claim Information panel of a professional claim in the provider portal.
  • For electronic claims, the first date of care will be billed in the Initial Treatment Date field of the professional claim form.
  • For CMS 1500 paper claim forms, field 15 will be utilized for required qualifier of “454” and the “Initial Treatment Date”.
  • If no Initial Treatment Date or an Invalid date is entered on either paper or electronic claim forms, an edit will set and deny the detail with the global procedure code on the claim.
  • The provider will no longer span dates of service on the claim line for the entire Global OB period of care.
  • Providers will bill the date of delivery on the claim line (as “from” and “to” Dates of Service)
  • The system will use the date of delivery and the first date of care to calculate and ensure that at least two months of care were given, thereby allowing payment for the Global OB service that was billed. If two months of care were not provided, the Global OB service will be denied; claims that fall into this category today are denied if two months of care were not provided.
  • If a Date of Service is a “spanned date” for a Global OB procedure billed, the detail will deny.

Streamlined Arkansas Medicaid Revalidation Available for Providers Enrolled in Medicare

Added 4/17/19
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.

New Final Rules

Added 1/17/20
Arkansas Medicaid has released a final rule for DHS Policy 1088 Participant Exclusion Rule. View or print DHS Policy 1088. (PDF, new window)

Added 12/20/19
Arkansas Medicaid has released a final rule for the Hospital/Spinal Muscular Atrophy Newborn Screening packet that recently promulgated. View or print the hospital final rules and cost impact statement. (PDF, new window)

New Provider Manual Updates

Added 1/7/20
Arkansas Medicaid released an ARKids First-B provider manual update. View or print the ARKIDS-3-18 transmittal letter. (Word, new window)
View or print changes to the ARKids First-B provider manual. (Word, new window)

Arkansas Medicaid released a Child Health Services/Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) provider manual update. View or print the EPSDT-1-18 transmittal letter. (Word, new window)
View or print changes to the EPSDT provider manual. (Word, new window)

Added 12/20/19
Arkansas Medicaid released a Hospital provider manual update. View or print the HOSPITAL-3-19 transmittal letter. (Word, new window)
View or print changes to the Hospital provider manual. (Word, new window)

New RA Messages

Added 1/9/20
Arkansas Medicaid released an RA message to Clinics - Early Intervention Day Treatment (EIDT) and Adult Developmental Day Treatment (ADDT) providers. View the RA message regarding EIDT and ADDT Claims. (Word, new window)

Added 1/2/20
Arkansas Medicaid released an RA message to all providers. View the RA message regarding Change in Use of Modifiers on Claims (Services) Requiring Prior Authorizations. (Word, new window)

Arkansas Medicaid released an RA message to all providers. View the RA message regarding Medication Assisted Treatment (ACT 964). (Word, new window)

Added 12/26/19
Arkansas Medicaid released an RA message to Hospital and Rehabilitative Hospital providers. View the RA message regarding MUMP Prior Authorization Extensions. (Word, new window)

Added 12/19/19
Arkansas Medicaid released an RA message to all providers. View the RA message regarding Provider Electronic Solutions (PES) Transition. (Word, new window)