Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.17-024 - SecIII-2-17: Billing

Current through Register Vol. 49, No. 6, June, 2024
300.000
GENERAL INFORMATION
301.000 Introduction
The purpose of Section III of the Arkansas Medicaid Manual is
				to explain the general procedures for billing In the Arkansas Medicaid
				Program.
Two major areas are covered in this section:
A. General Information: This section contains
			 information about electronic options, timely filing of claims, claim inquiries
			 and supply procedures.
B. Financial
			 Information: This section contains information on the Remittance Advice (RA),
			 reports; adjustments, refunds and additional payment sources,
301.100 Electronic Claims Submission
The Arkansas Medicaid fiscal agent furnishes both an online
				portal and software for electronic claims submissions. X.I2 companion documents
				are also offered at no charge to the provider for transactions utilized by
				Arkansas Medicaid.
When submitting claims electronically, Medicaid providers
				should use the claim type iriformation found in the Section II of their
				program's provider manual.
The Arkansas Medicaid fiscal agent processes payments for each
				week's accumulations of claims during a weekend cycle. The deadline for each
				weekend cycle is midnight Friday. providers are paid the following week.
301.105 Modifiers For Electronic
			 Billing
Electronic claims may require modifiers in addition to National
				Standard Codes. Please refer to the Section II of your program's provider
				manual to determine the appropriate modifiers.
301.110 Arkansas Provider Portal
Providers with PCs can submit claims via the web using an
				Internet browser. (Please see
https://www.medicaid.state.ar.us/Provider/faq/faa.aspx#svsreqportal
for system requirements.) Dental, Professional, and Institutional claim types
can
be submitted via the we!? including long-term care census.
				Claims can only be submitted interactively (one at a time). Access the provider
				portal via the Arkansas Medicaid website at
https://www.medicaid.state.ar.us/
.
				The web-based provider portal was designed to integrate seamlessly with the
				Arkansas Medicaid Management Information System (MMIS) and is, therefore, the
				preferred method for electronic transactions.
Instructions for submitting claims and verifying eligibility
				via the portal are available by using the site's online Help
				feature.
301.120 Provider
			 Efectronic Solutions (PES) Software
Provider Electronic Solutions {PES)"software iravailable at no
				cost to any provider who submits Medicaid claims. PES supports submission of
				claims in a batch mode only. (Please see
https://www.medicaid.state.ar.us/Provtder/faq/faq.aspx#svsreapes
for system requirements.) The software supports dental, institutional and
				professional claim types. In' addition to submitting claims, providers can also
				view claim responses using PES software. Instructions for using PES software
				are available by using the application's Help feature.
301.130 Vendor Systems
Providers who have office management systems can opt to have
				their vendors upgrade their systems to support online transactions. The
				Arkansas Medicaid fiscal agent provides X.I 2 companion guides to interested
				vendors. The cost of upgrading the provider's system to support online
				transactions is the responsibility of the provider.
301.200 Electronic Transactions
The Arkansas Medicaid fiscal agent offers electronic
				transactions that are compliant with Health Insurance Portability and
				Accountability Act (HIPAA) regulations through both the provider portal and
				Provider Electronic Solutions (PES) software.
301.210 Eligibility Verification
Providers can check a beneficiary's eligibility through the
				provider portal via the web, using PES software or through the Voice Response
				System (VRS). To access the VRS, providers can call the Provider Assistance
				Center automated help line.
View or print the Provider Assistance
				Center contact information.
Eligibility requests can be submitted interactively through the
				provider portal via the web or in a batch using PES software. Instructions for
				verifying eligibility through the provider portal are available using the
				site's online Help feature. Instructions for using PES are available by using
				the application's Help feature or the PES Handbook on the Arkansas Medicaid
				website at
httDs://
www.medicaid.state.ar.us/Download/provider/software/pes/peshandbook.pdf
.
301.220 Claim Status Inquiry
Providers can check the status of one or more claims through
				the provider portal or PES software. Claim status requests can be submitted
				interactively (one at a time) via the provider portal or through PES in a batch
				mode. Claim status requests can be submitted interactively (one at a time) via
				the web. Instructions for checking a claim status via the provider portal are
				available by using the site's online Help feature. Instructions for checking a
				claim status using PES software are available using the application's Help
				feature or the PES Handbook on the Arkansas Medicaid website at
https://www.medicaid.state.ar.us/Download/provider/software/pes/peshandbook.pdf
.
Providers with vendor systems can also check a claim's status
				by utilizing the ASC X.I2 501OA 276/277 transactions with the appropriate X.12
				companion guide.
301.230
			 Remittance Advice Reports
Providers can retrieve their electronic Remittance Advice (RA)
				reports through the proviBer portal or with PES software. Instructions for
				retrieving RAs using PES software are available using the application's Help
				feature.
Providers with vendor systems can also receive remittance
				advice reports by utilizing the ASC X.12 501 OA 835 transaction with the
				appropriate X.12 companion guide,
301.240 Prior Authorization Request
Providers can review instructions for Prior Authorization
				Requests in the Section II of thej.r program's provider manuaj.'
Some pjjor authorizations are processed by other Medicaid
				contractors:
A. Arkansas Foundation
			 for Medical Care (AFIVIC) can assist with the Medicaid Utilization
			 l\/lanagement Process, surgical procedures, assistant surgeons, transplants,
			 anesthesia; orthotics and prosthetics, inpatient sen/ices, tab and radiology,
			 lab-molecular pathology, rehabilitation hospitals, personal care for
			 beneficiaries under age 21, Child Health Management Services, and Professional
			 Services including extension of benefits for Podiatry and Professional level
			 visits.
View or print contact information for Arkansas'
			 Foundation for Medical Care. Retrospective Review for Therapy and Prior
			 Authorization for Personal Care for Under Age 21.
B. Beacon Health Options can
			 assist with PAs for Inpatient Psychiatric Services, Outpatient Behavioral
			 Health Services and Substance Abuse Services.
View or print
			 contact information for Beacon Health Options
.
301.300
Contacts
The Arltansas Medicaid fiscal agent maintains a Provider
				Assistance Center (PAC) to assist Medicaid providers during regular business
				hours from 8:00 a.m. to 5:00 p.m. Central Standard Time.
View
or
print PAC
contact
information.
The Arkansas Medicaid fiscal agent also has a staff of
				representatives available during regular business hours from 8:00 a.m. to 5:00
				p.m. to assist with any needs concerning electronic solutions.
View or print PAC contact information.