What’s New for Arkansas Medicaid Providers
Content updated August 20, 2018
All systems are currently online.
EIDT and ADDT Providers
Denials for EOB 0978
Procedure Code A4927 – Gloves, Non-Sterile, Per 100
Early Intervention Day Treatment (EIDT) and Adult Developmental Day Treatment (ADDT) Implementation
AIPT Contact Information
Prior Authorized Hearing Services
RSPMI/OBHS Providers – ACTION required NOW
Rendering Provider Enrollment
OBHS (former RSPMI) Billing
Monthly System Maintenance
PES Trouble-Shooting Notes
New Official Notices
New Provider Manual Updates
New RA Messages
Since the ADDT and EIDT programs went live on August 1, 2018, we have noticed a significant number of claim denials for EOB 0863 - PROC CODE IS OUTSIDE AGREED UPON CONTRACT. It has been determined that this denial occurs when providers have both an EIDT and ADDT specialty and contract on file. Currently, the provider file only allows one specialty to be marked as primary and then uses that specialty to further process the claim. DXC is working on a solution and will identify and reprocesses all claims that incorrectly denied with EOB 0863. We apologize for the inconvenience and will update this bulletin when this issue has been resolved.
This issue has been resolved; these claims can now be submitted. Incorrectly denied claims were reprocessed in the financial cycle on August 10. When billing CHMS/DDTCS services with dates of service prior to 8/1/2018 for providers who also had the new specialties for EIDT/ADDT/AMC added to their provider number, the system is not properly recognizing the CHMS/DDTCS specialties. This is causing these claims to deny with EOB 0978 – in relation to effective DOS of provider specialty; Provider is ineligible to render this service. We expect this issue to be corrected very soon and we’ll post an update once it’s complete. Any claims that have denied inappropriately will be reprocessed. We apologize for any inconvenience.
On and after July 1, 2018, the Arkansas Medicaid rate will be $5.22 for procedure code A4927 (Gloves, non-sterile, per 100) to correspond with Arkansas Medicaid Prosthetic Program Reimbursement Methodology.
As a reminder, dentists who are part of a managed care organization are eligible for deferred comp through the Diamond Plan when billing fee for service.
DHS is happy to announce that we have received CMS approval for the Early Intervention Day Treatment (EIDT) and Adult Developmental Day Treatment (ADDT) program, and implementation of these successor programs will begin August 1, 2018.
Please review the EIDT Medicaid Manual for specific eligibility requirements for EIDT, as these requirements will go into effect August 1 for new enrollees. Beneficiaries who enrolled in CHMS or DDTCS prior to August 1, 2018 will be grandfathered into the EIDT program. However they must continue to meet the eligibility criteria for either CHMS or DDTCS to remain eligible to receive services. The grandfather period will sunset on July 1, 2019, at which time all children in the EIDT program must meet the new eligibility criteria.
Eligibility requirements for ADDT have not changed. The billing codes for EIDT and ADDT will be available for any service completed on or after August 1, including transportation. View the EIDT and ADDT manuals.
It is important that you take the necessary steps to add the EIDT or ADDT specialty to your current Type 24 Provider ID. The Division of Provider Services and Quality Assurance detailed these steps in a memorandum issued on June 25, 2018. If you do not complete these steps, your billing for the successor programs will be denied.
For CHMS providers, DDS has worked with several of you and our current vendor, AFMC, to extend existing prior authorizations so that you can continue to bill until EIDT begins. Plans to implement EIDT and ADDT on Monday, July 30 to start with a new billing cycle were delayed to allow testing; therefore, EOBs shall be extended to July 31 instead of July 29.
We are currently experiencing technical difficulties with the Arkansas Incentive Payment Team email address. Until further notice, please direct all AIPT inquiries and documentation to firstname.lastname@example.org or call 1-800-457-4454.
Beginning 7/2/2018 providers of Hearing Services will be required to use Prior Authorization (PA) process type “107 - Hearing Services” instead of “112 - Other Medical Services” when requesting PAs. Process type “112 - Other Medical Services” can no longer be used for Hearing Services PA requests. Selecting the incorrect process type will cause your PA requests to deny.
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.
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 official notice for all providers regarding 2018 Current Procedural Terminology (CPT®) Code Conversion. View or print ON-002-18. (Word, new window)
Arkansas Medicaid released an official notice for all providers regarding 2018 Healthcare Common Procedure Coding System Level II (HCPCS) Code Conversion and Code on Dental Procedures and Nomenclature (CDT) Conversion. View or print ON-001-18. (Word, new window)
Arkansas Medicaid released a Federally Qualified Health Center (FQHC) provider manual update. View or print the FQHC-1-18 transmittal letter. (Word, new window)
View or print changes to the FQHC provider manual. (Word, new window)
Arkansas Medicaid released a Hospital provider manual update. View or print the HOSPITAL-1-18 transmittal letter. (Word, new window)
View or print changes to the Hospital provider manual. (Word, new window)
Arkansas Medicaid released a Physician provider manual update. View or print the PHYSICN-1-18 transmittal letter. (Word, new window)
View or print changes to the Physician provider manual. (Word, new window)
Arkansas Medicaid released a Rural Health provider manual update. View or print the RURLHLTH-1-18 transmittal letter. (Word, new window)
View or print changes to the Rural Health provider manual. (Word, new window)
Arkansas Medicaid released an ARKids First-B provider manual update. View or print the ARKIDS-1-18 transmittal letter. (Word, new window)
View or print changes to the ARKids First-B provider manual. (Word, new window)
Arkansas Medicaid released a Hospice provider manual update. View or print the HOSPICE-3-18 transmittal letter. (Word, new window)
View or print changes to the Hospice provider manual. (Word, new window)
Arkansas Medicaid released a Prosthetics provider manual update. View or print the PROSTHET-2-18 transmittal letter. (Word, new window)
View or print changes to the Prosthetics provider manual. (Word, new window)
Arkansas Medicaid released a Section III all provider manuals update. View or print the SecIII-1-18 transmittal letter. (Word, new window)
View or print changes to Section III of all provider manuals. (Word, new window)
Arkansas Medicaid released an RA message to Home Health and Prosthetics (DME) providers.
View the RA message regarding Procedure Code A4927 – Gloves, Non-Sterile, Per 100. (Word, new window)
Arkansas Medicaid released an RA message to Dental providers.
View the RA message regarding Deferred Comp. (Word, new window)