What’s New for Arkansas Medicaid Providers
Content updated June 21, 2018
Edit 1010 Adjustments on 6/28/2018
Work Requirement for Some Arkansas Works Beneficiaries
RSPMI/OBHS Providers – ACTION required NOW
Rendering Provider Enrollment
OBHS (former RSPMI) Billing
Approvals from MCOs
EHR Program Name Change
Monthly System Maintenance
PES Trouble-Shooting Notes
New Provider Manual Updates
New RA Messages
If you have claims that paid with a rendering provider that was NOT enrolled in your group, they will be adjusted and denied on your 6/28/2018 RA. A system update has been applied to correct claims that incorrectly paid when the Rendering Provider was not affiliated with the Billing Provider Group on the claim date of service. All incorrectly paid claims from 11/01/2017 through 5/29/2018 will be adjusted to deny for edit 1010 - RENDERING PROV NOT MEMBER OF BILLING PROV GROUP. We apologize for any inconvenience this may have caused you.
View or print Section IV - Group Affiliation form used to link providers to a group. (Word, new window)
Some Arkansas Works beneficiaries ages 30-49 must now meet a work requirement to keep their health care coverage. Providers are encouraged to ask if beneficiaries have this requirement and whether they have logged onto www.access.arkansas.gov (HTML, new window) to report their activities to meet this requirement. Additional information about the beneficiary’s status may be available from their QHP. If beneficiaries have questions or need assistance, they should call 1-855-372-1084.
Current policy requires rendering providers to be
- Fully enrolled as a credentialed provider.
Fully enrolled, credentialed providers must bill using their NPI in the rendering provider field. These providers are certified and considered medical professionals who have an independent license (e.g. Physician, Psychologist, LCSW, LPC).
- A registered, non-credentialed provider.
Non-credentialed providers must use a Practitioner Identification Number (PIN) in the rendering provider field. These providers are mental health para professionals, peer specialists, RNs, and behavioral health counselors who do not have an independent license (e.g. LMSW, LAC)
RSPMI providers have been able to bill without entering the NPI or PIN in the rendering provider field. Effective immediately, you must use the rendering provider NPI or PIN if they are currently enrolled. If your rendering providers are not yet enrolled, prepare for this policy to be enforced in claims processing and enroll your rendering providers today!
During this time period it is important to ensure the integrity of the program. Compliance will be monitored by a review of billing provider claims submissions. Billing providers that do not submit claims with current NPI for professionals may be subject to audits of professional service claims.
Your first step to ensure correct claims processing is to confirm that your rendering providers are enrolled. For detailed information on how to determine if your rendering provider needs an NPI or a PIN, please refer to Section 213.00 - Staff Requirements of the RSPMI provider manual (Word, new window). All enrollment applications for rendering providers must be received by August 1, 2018 to ensure they receive a PIN or provider ID prior to the policy being enforced in claims processing.
We are requesting a staggered approach to enable targeted technical assistance with the process. Please submit PIN requests for behavioral health counselors who do not have an independent license prior to June 30, 2018. This will allow processing prior to the August 1, 2018 deadline. You can submit all requests prior to June 30, 2018 to identify any issues in July if that is your preference.
Credentialed Fully Participating Providers
To enroll as a rendering provider, you must first have an NPI and then complete the web-based Arkansas Medicaid enrollment application (HTML, new window) to receive an Arkansas Medicaid provider ID.
Please ensure that your information is complete, accurate and that ALL requested information is attached or uploaded to the portal.
If you have a rendering provider who is currently enrolled, but has not reported their NPI to Arkansas Medicaid, complete the NPI Reporting form (Word, new window) and return to DXC for processing.
Non-Credentialed Providers (PIN)
To enroll for a Practitioner Identification Number (PIN), complete DMS-7708 - Practitioner Identification Number Request form (Word, new window). Return the completed form to DXC for processing. Non-credentialed providers are NOT required to have an NPI. If your non-credentialed rendering provider has an NPI, it cannot be linked to a PIN and you will not be able to bill using this NPI.
The form must be completed in its entirety for DXC to expedite processing and issue a PIN. View a completed sample form for reference (Word, new window).
See more Provider Enrollment Information.
September 1, 2018, all OBHS (former RSPMI) providers must bill using a valid rendering provider ID or PIN.
While NPI numbers can be entered in the rendering provider field on ANY system, Practitioner Identifier Numbers cannot be submitted in the rendering provider field if you use a vendor system (billing company or clearing house).
For the proper location of the PIN when using a vendor system, the following information must be communicated to your vendor:
REF*G2* (Provider ID)
If PINs are billed in any other location, your claim will deny indicating that a rendering provider is needed.
Please note: Each detail of a claim must indicate the appropriate rendering provider. Only details with the same rendering provider can have spanned dates of service.
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
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.
To reflect CMS’s commitment to interoperability of health care data and patients’ access to their health information, the Electronic Health Record (EHR) Incentive Program is being overhauled. Effective immediately, the EHR Incentive Program will change to the Promoting Interoperability (PI) Program. The MIPS Advancing Care Information performance category will be known as the Promoting Interoperability performance category.
This rebranding does not merge the EHR Incentive Program and MIPS. Instead, these changes reflect CMS’s mission to move these programs beyond the current Meaningful Use requirement to an increased focus on interoperability and ease of patient access to health information. In the coming weeks, CMS will update its websites and educational resources to reflect these changes.
System maintenance is scheduled on the first and third Saturday of each month from 9:00 p.m. to 2:00 a.m. and on the last Tuesday of each month from 7:00 p.m. to 9:00 p.m. During these maintenance periods, you may not be able to verify eligibility or submit claims interactively. Batch transactions received during these periods will be held in queue and will be processed as soon as maintenance is complete. Pharmacy claims will not be affected.
For the latest billing news, see Billing Bulletins.
If you’re having trouble using Provider Electronic Solutions software, please see PES Trouble-Shooting Notes.
Arkansas Medicaid released an Adult Development Day Treatment (ADDT) provider manual update. View or print the ADDT-New-18 transmittal letter. (Word, new window)
View or print the ADDT provider manual. (Word, new window)
Arkansas Medicaid released a Child Health Management Services (CHMS) provider manual update. View or print the CHMS-1-18 transmittal letter. (Word, new window)
Arkansas Medicaid released a Developmental Day Treatment Clinic Services (DDTCS) provider manual update. View or print the DDTCS-1-18 transmittal letter. (Word, new window)
Arkansas Medicaid released an Early Intervention Day Treatment (EIDT) provider manual update. View or print the EIDT-New-18 transmittal letter. (Word, new window)
View or print the EIDT provider manual. (Word, new window)
Arkansas Medicaid released an Occupational, Physical, and Speech Therapy Services provider manual update. View or print the THERAPY-1-18 transmittal letter. (Word, new window)
View or print changes to the Occupational, Physical, and Speech Therapy Services provider manual. (Word, new window)
Arkansas Medicaid released a Transportation provider manual update. View or print the TRANSP-1-18 transmittal letter. (Word, new window)
View or print changes to the Transportation provider manual. (Word, new window)
Arkansas Medicaid released a Section V all provider manuals update. View or print the SecV-3-18 transmittal letter. (Word, new window)
View or print changes to Section V of all provider manuals. (Word, new window)
View or print changes to Form DMS-632. (Word, new window)
View or print changes to Form DMS-638. (Word, new window)
Arkansas Medicaid released an RA message to all providers.
View the RA message regarding Work Requirement for Some Arkansas Works Beneficiaries. (Word, new window)
Arkansas Medicaid released an RA message to all providers.
View the RA message regarding Edit 1010 Adjustments on 6/28/2018. (Word, new window)
Arkansas Medicaid released an RA message to Outpatient Behavioral Health Services (OBHS) and Rehabilitative Services for Persons with Mental Illness (RSPMI) providers.
View the RA message regarding Action Required Now. (Word, new window)
Arkansas Medicaid released an RA message to Nursing Facilities, Intermediate Care for Individuals with Intellectual Disabilities and Hospice providers.
View the RA message regarding Level of Care. (Word, new window)