Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.05-016 - Visual Care Update Transmittal #62

Current through Register Vol. 49, No. 6, June, 2024
Section
			 II
Visual Care
201.000
Arkansas Medicaid
			 Participation Requirements for Visual Care Providers
Visual Care Program providers meeting the following criteria
				are eligible for participation in the Arkansas Medicaid Program:
A. Provider must be licensed by the State
			 Board of Optometry to practice in his or her state. A current copy of the
			 optometrist's license must be submitted with the provider application for
			 participation. Subsequent licensure must be provided when issued.
B. Provider must be enrolled in the Title
			 XVIII (Medicare) Program.
C.
			 Provider must complete a provider application (Form DMS-652), a Medicaid
			 contract (Form DMS-653) and a Request for Taxpayer Identification Number and
			 Certification (Form W-9).
View or print the provider
			 application (Form DMS-652), the Medicaid contract (Form DMS-653) and the
			 Request for Taxpayer Identification Number and Certification (Form
			 W-9).
D. The
			 Arkansas Medicaid Program must approve the provider application and the
			 Medicaid contract as a condition of participation in the Medicaid Program.
			 Persons and entities that are excluded or debarred under any state or federal
			 law, regulation or rule are not eligible to enroll, or to remain enrolled, as
			 Medicaid providers.
Visual Care Providers in Arkansas and Bordering
				States
Visual Care Program providers in Arkansas and the bordering
				states of Louisiana, Mississippi, Missouri, Oklahoma, Tennessee and Texas will
				be enrolled as routine services providers.
Routine Services Providers
A. Provider will be enrolled in the program
			 as a regular provider of routine services.
B. Reimbursement will be available for all
			 visual care services covered in the Arkansas Medicaid Program.
C. Claims must be filed according to section
			 240.000 of this manual. This
			 includes assignment of ICD-9-CM and HCPCS codes for all services
			 rendered.
Visual Care Providers in Non-Bordering
				States
All Visual Care Program providers in non-bordering states may
				be enrolled only as limited services providers.
Limited Services Providers
A. Providers will be enrolled in the program
			 to provide prior authorized or emergency services only.
"Emergency services" are defined as inpatient or outpatient
				hospital services that a prudent layperson with an average knowledge of health
				and medicine would reasonably believe are necessary to prevent death or serious
				impairment of health and which, because of the danger to life or health,
				require use of the most accessible hospital available and equipped to furnish
				those services. Source: 42 U.S. Code of Federal Regulations §
											422.2 and §
											424.101.
"Prior authorized services" are those that are medically
				necessary and not available in Arkansas. Each request for these services must
				be made in writing, forwarded to the Utilization Review Section and approved
				before the service is provided. An Arkansas Medicaid Provider Contract must be
				signed before reimbursement can be made. A provider number will be assigned
				upon receipt and approval of the provider application and
Medicaid contract.
View or print the Division
				of Medical Services, Utilization Review Section contact
				information
.
B.
			 Limited Services provider claims will be manually reviewed prior to processing
			 to ensure that only emergency or prior authorized services are approved for
			 payment. These claims should be mailed to the Arkansas Division of Medical
			 Services, Program Communications Unit.
View or print the
			 Division of Medical Services, Program Communications Unit contact
			 information.