Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.05-036 - Section III - All Medicaid Provider Manuals

Current through Register Vol. 49, No. 6, June, 2024
Provider Manual
Transmittal Number
Alternatives for Adults with Physical Disabilities
						  Waiver...........................................................
21
Ambulatory Surgical
						  Center.....................................................................................................
52
ARKids
						  First-B.........................................................................................................................
18
Certified
						  Nurse-Midwife............................................................................................................
54
Child Health Management
						  Services..........................................................................................
53
Child Health Services/Early and Periodic Screening,
						  Diagnosis and Treatment.......................
58
Children's Services Respite
						  Care...............................................................................................
7
Children's Services Targeted Case
						  Management.......................................................................
7
Chiropractic...............................................................................................................................
50
DDS Alternative Community Services
						  Waiver...........................................................................
45
Dental........................................................................................................................................
71
Developmental Day Treatment Clinic
						  Services........................................................
						  .........
56
Developmental Rehabilitation
						  Services...........................................................................
7
Domiciliary
						  Care.......................................................................................................................
37
ElderChoices Home and Community-Based 2176
						  Waiver.....................................................
69
Federally Qualified Health
						  Center.............................................................................................
43
Hearing
						  Services......................................................................................................................
47
Home
						  Health...........................................................................................................................
64
Hospice.....................................................................................................................................
37
Hospital/End-Stage Renal
						  Disease...........................................................................................
69
Hyperalimentation....................................................................................................................
60
Inpatient Psychiatric Services for Under Age
						  21.......................................................................
55
Licensed Mental Health
						  Practitioners........................................................................................
39
Living Choices Assisted
						  Living...................................................................................................
7
Medicare/Medicaid Crossover
						  Only..........................................................................................
33
Nurse
						  Practitioner....................................................................................................................
47
Occupational, Physical, Speech Therapy
						  Services...................................................................
39
Personal
						  Care..........................................................................................................................
60
Pharmacy..................................................................................................................................
69
Physician/Independent Lab/CRNA/Radiation Therapy
						  Center..................................................
90
Podiatrist...................................................................................................................................
48
Portable X-Ray
						  Services..........................................................................................................
42
Private Duty Nursing
						  Services................................................................................................
.52
Prosthetics...............................................................................................................................
.62
Rehabilitative
						  Hospital..............................................................................................................
.46
Rehabilitative Services for Persons with Mental
						  Illness...........................................................
.52
Rehabilitative Services for Persons with Physical
						  Disabilities..................................................
.27
Rehabilitative Services for Youth and
						  Children.......................................................................
...8
Rural Health Clinic
						  Services.....................................................................................................
.43
School-Based Mental Health
						  Services.....................................................................................
.12
Targeted Case
						  Management..................................................................................................
.47
Transportation..........................................................................................................................
.62
Ventilator
						  Equipment................................................................................................................
.45
Visual
						  Care..............................................................................................................................
57
302.400
Claims With Retroactive Eligibility
Retroactive eligibility does not constitute an exception to the
				filing deadline policy. If an appeal or other administrative action delays an
				eligibility determination, the provider must submit the claim within the
				12-month filing deadline. If the claim is denied for recipient ineligibility,
				the provider may resubmit the claim when the patient becomes eligible for the
				retroactive date(s) of service. Medicaid may then consider the claim for
				payment because the provider submitted the initial claim within the 12-month
				filing deadline and the denial was not the result of an error by the
				provider.
Occasionally the State Medicaid agency or a federal agency,
				such as the Social Security Administration, is unable to complete a Medicaid
				eligibility determination in time for service providers to file timely claims.
				Arkansas Medicaid's claims processing system is unable to accept a claim for
				services provided to an ineligible individual or to suspend that claim until
				the individual is retroactively eligible for the claim dates of service.
To resolve this dilemma, Arkansas Medicaid considers the pseudo
				recipient identification number 9999999999 to represent an "...error
				originating within (the) State's claims system." Therefore, a claim containing
				that number is a clean claim
if it contains all other information
				necessary for correct processing
.
By defining the initial timely filed claim as a clean claim
				denied because of agency processing error, we may allow the provider to refile
				the claim when the government agency completes the eligibility determination.
				With the claim, the provider must submit proof of the initial filing and a
				letter or other documentation sufficient to explain that administrative
				processes (such as determination of SSI eligibility) prevented the resubmittal
				before the filing deadline.
To submit a claim for services provided to a patient who is not
				yet eligible for Medicaid enter, on the claim form or on the electronic format,
				a pseudo Medicaid recipient identification number, 9999999999. Medicaid will
				deny the claim. Retain the denial or rejection for proof of timely filing if
				eligibility determination occurs more than 12 months after the date of
				service.
Providers have 12 months from the approval date of the
				patient's Medicaid eligibility to resubmit a clean claim after filing a pseudo
				claim. After the 12-month filing deadline (12 months from the Medicaid approval
				date) claims will be denied for timely filing and will not be paid. It is the
				responsibility of the provider to verify the eligibility approval date.
332.300
Adjustments by
			 Medicare
Any adjustment made by Medicare will not be automatically
				forwarded to Medicaid. If Medicare makes an adjustment that results in an
				overpayment or underpayment by Medicaid, the provider must submit an Adjustment
				Request Form (EDS-AR-004) with a copy of the appropriate red-lined crossover
				form reflecting Medicare's adjustment. Enter the Medicaid provider number and
				the patient's Medicaid identification number on the red-lined crossover
				form.
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