• Provider enrollment

• Claims processing

• Remittance

• Provider relations

• Medicaid Management Information System (MMIS)

HP Enterprise Services Medicaid Fiscal Agent

Beneficiary Eligibility

• ARKids First-B -$10.00 co-payment

• Medicaid Eligible children 9-21 years old

• Pregnant Women

• Pregnant women are covered through the last day of the month in which the 60th post-partum day falls

Beneficiary Eligibility

Verify Eligibility

1. Go to www.medicaid.state.ar.us

2. Click on “Provider”

3. Click on “Log on”

Log on

4. Enter User ID and Password

• User ID • 9-digit Medicaid ID number

• Initial password (will be prompted to change)

•For individual provider: SSN•For group/facility: Tax ID number

Log on

• RECEIVED DATE: 04/16/2010• ----------------------------------------------• I N F O R M A T I O N S O U R C E

• INFORMATION SOURCE: ARKANSAS MEDICAID• SOURCE PRIMARY ID: xxxxxxxxx• ----------------------------------------------• P R O V I D E R I N F O R M A T I O N

• PROVIDER LAST NAME: DRLAST• PROVIDER FIRST NAME: DRFIRST• PROVIDER NUMBER: xxxxxxxxxx• ----------------------------------------------• B E N E F I C I A R Y I N F O R M A T I O N

• (continued next)

Who information is coming from

Pay-To provider name

Pay-To provider number

271 Request Response File Verifying Eligibility

• ----------------------------------------------• R E C I P I E N T I N F O R M A T I O N

• ELIGIBILITY• AUTHORIZATION #: 12345678901234

• TRACE #: 999999999999999• RECIPIENT LAST NAME: DOE• RECIPIENT FIRST NAME: JOHN• RECIPIENT ID: XXXXXXXXXX• RECIPIENT DOB: 01/01/2000• -----------------------------------------------• E L I G I B I L I T Y I N F O R M A T I O N

• (continued next)

Authorization numberTrace number

Beneficiary name as it appears with AR Medicaid

Keyed ID number

DOB listed with Medicaid

271 Request Response FileVerifying Eligibility

----------------------------------------------E L I G I B I L I T Y I N F O R M A T I O N

ELIGIBILITY/BENEFIT: 1 ACTIVE COVERAGEPLAN DESCRIPTION: 01ARKIDS 1STELIGIBILITY PERIOD: 01/01/2010-04/16/2010COUNTY: 731 XXXX

ELIGIBILITY/BENEFIT: R TPLINSURANCE TYPE: C1 COMMERCIALTPL MEMBER #: XXXXXXXXXTPL POLICY #: XXXXXXXTPL GROUP #: XXXXXXPLAN NAME: XXXX INSURANCEELIGIBILITY PERIOD: 01/01/2010 – 04/16/2010COVERAGE 1: FULL COVERAGELAST/ORG NAME: XXXX INSURANCECOMPANY CODE: XXXADDRESS LINE 1: P.O. BOX XXXXCITY: LITTLE ROCKSTATE: ARZIP: 72201

(continued next)

Shows coverage

TPL information

Aid category

Dates of eligibility

County of residence

Type of TPL

Member numberPolicy number

Group number

Plan name

Type of coverage

Dates of coverage

Name of insurer

Company code

Address

271 Request Response FileVerifying Eligibility

(continued previous)----------------------------------------------E L I G I B I L I T Y I N F O R M A T I O N

ELIGIBILITY/BENEFIT: L PRIMARY CARE PROVIDERDATE TIME PERIOD: 01/01/2010 – 04/16/2010LAST/ORG NAME: PCPLASTFIRST NAME: PCPFIRSTNAME SUFFIX: MDTELEPHONE: 5013746608

ELIGIBILITY/BENEFIT: D BENEFIT DESCRIPTIONSERVICE TYPE: 5 (DIAGNOSTIC LAB)MONETARY AMOUNT: 100.00

ELIGIBILITY/BENEFIT: D BENEFIT DESCRIPTIONSERVICE TYPE: PHYSICIAN VISITSDATE TIME PERIOD: 02

PCP information

PCP’s name and phone number returned if applicable

NOTE: Only benefits used will appear on eligibility response

PCP effective dates

271 Request Response FileVerifying Eligibility

• Up to 4 beneficiary eligibility segments with matching beneficiary IDs

• EPSDT screening information

• Medicare A and B effective dates

Supplemental EligibilityVerifying Eligibility

• Provider must be located within the state of Arkansas

• PCP referral not required

• All services require PA except:– H0001-Addiction Assessment-New Beneficiary

– T1007-Treatment Planning-New Beneficiary

– PA numbers will begin with V9

Medicaid General Requirements

• Medicaid will not cover any SATS without a current prescription signed by a psychiatrist or physician

• Services cannot begin prior to the date of the psychiatrist’s or physician’s signature on the treatment plan (except Addiction Assessment-H0001)

Prescription for Substance Abuse Treatment Services (SATS)

• Allowable place of service office-11(SATS Facility Service Site)

• Professional claim –CMS-1500

• Cannot span dates of services unless the dates are consecutive

• Yearly services benefits are based on the state fiscal year (July 1 to June 30)

Outpatient Only Services

SATS must be billed on a per unit basis, as reflected in a daily total, per beneficiary, per SAT service.

Time spent providing services for a single beneficiary may be accumulated during a single, 24-hour calendar day. Providers may accumulatively bill for a single date of service, per beneficiary, per SAT service. Providers are not allowed to accumulatively bill for spanning dates of service.

All billing must reflect a daily total, per SAT service, based on the established procedure codes. No rounding is allowed.

One (1) unit = 8 - 24 minutes

Two (2) units = 25 - 39 minutesThree (3) units = 40 - 49 minutesFour (4) units = 50 - 60 minutes

SATS Units

Services not covered under the SATS Program include, but are not limited to:

• Room and board residential cost

• Educational services

• Telephone contacts with beneficiary or collateral

• Transportation services, including time spent transporting a beneficiary for services (Reimbursement for SAT services is not allowed for the period of time the Medicaid beneficiary is in transport.)

• SAT services that are determined as not medically necessary

• SAT services that duplicate integral and inseparable parts of other Medicaid services when provided on the same date of service

Exclusions

Contacts

HP Enterprise Services

• Toll-free in Arkansas (800) 457-4454

• Local or out-of-state (501) 376-2211

• Fax (501) 374-0549Monday-Friday (8 a.m. – 5 p.m.)

Medicaid Provider Enrollment Unit:HP Enterprise ServicesPO Box 8105 Little Rock, AR 72203-8105Fax: 501-374-0746

HP Enterprise Services Electronic Data Interchange (EDI)

Assists providers with electronic claim submission issues, 997 batch responses, PES software delivery and setup support, software training and data transmission failures.

•Toll-free in Arkansas (800) 457-4454

•Local or out-of-state (501) 376-2211

Monday-Friday (8 a.m. – 5 p.m.)

HP Enterprise Services Research Analyst

Answers emails sent to region mailboxes, researches claims issues from providers and submits eligible claims with appropriate override.

To contact the research analyst, attach a cover letter explaining the reason for your inquiry to an original red and white claim form and mail to:

HP Enterprise ServicesAttn: Research AnalystPO Box 8036Little Rock, AR 72203

HP Enterprise Services Provider Representatives

Handle billing and policy issues that have been escalated from the Provider Assistance Center. They are by appointment for on-site visits.

See the Arkansas Medicaid website to find the provider representative for your county.

You may contact your provider representative by calling (501) 374-6609 and entering their extension.

Contact Information

Questions?