Provider enrollment

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HP Enterprise Services
Medicaid Fiscal Agent

• Provider enrollment
• Claims processing
• Remittance
• Provider relations
• Medicaid Management Information System (MMIS)

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Beneficiary Eligibility
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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

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Verify Eligibility
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Log on

1. Go to www.medicaid.state.ar.us
2. Click on Provider
3. Click on Log on

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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

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Verifying Eligibility
271 Request Response File

• 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
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Who information is coming from
Pay-To provider name
Pay-To provider number
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Verifying Eligibility
271 Request Response File

• ----------------------------------------------
• 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
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Authorization number
Trace number
Beneficiary name as it appears with AR Medicaid
Keyed ID number
DOB listed with Medicaid
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Verifying Eligibility
271 Request Response File
Shows coverage
---------------------------------------------- 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 COVERAGE PLAN
DESCRIPTION 01ARKIDS 1ST ELIGIBILITY
PERIOD 01/01/2010-04/16/2010 COUNTY 731
XXXX ELIGIBILITY/BENEFIT R TPL INSURANCE
TYPE C1 COMMERCIAL TPL MEMBER
XXXXXXXXX TPL POLICY XXXXXXX TPL GROUP
XXXXXX PLAN NAME XXXX INSURANCE ELIGIBILIT
Y PERIOD 01/01/2010 04/16/2010 COVERAGE
1 FULL COVERAGE LAST/ORG NAME XXXX
INSURANCE COMPANY CODE XXX ADDRESS LINE
1 P.O. BOX XXXX CITY LITTLE
ROCK STATE AR ZIP 72201
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Aid category
Dates of eligibility
County of residence
TPL information
Type of TPL
Member number
Policy number
Group number
Plan name
Dates of coverage
Type of coverage
Name of insurer
Company code
Address
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Verifying Eligibility
271 Request Response File
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----------------- 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 PROVIDER DATE TIME PERIOD
01/01/2010 04/16/2010 LAST/ORG
NAME PCPLAST FIRST NAME PCPFIRST NAME
SUFFIX MD TELEPHONE [phone]
ELIGIBILITY/BENEFIT D BENEFIT
DESCRIPTION SERVICE TYPE 5 (DIAGNOSTIC
LAB) MONETARY AMOUNT 100.00 ELIGIBILITY
/BENEFIT D BENEFIT DESCRIPTION SERVICE
TYPE PHYSICIAN VISITS DATE TIME PERIOD
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PCP information
PCP effective dates
PCPs name and phone number returned if
applicable
NOTE Only benefits used will appear on
eligibility response
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Verifying Eligibility
Supplemental Eligibility

• Up to 4 beneficiary eligibility segments with
  matching beneficiary IDs
• EPSDT screening information
• Medicare A and B effective dates

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Medicaid General Requirements

• 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

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Prescription for Substance Abuse Treatment
Services (SATS)

• 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
  psychiatrists or physicians signature on the
  treatment plan (except Addiction Assessment-H0001)

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Outpatient Only Services

• 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)

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SATS Units

• 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 minutes
Three (3) units 40 - 49 minutes
Four (4) units 50 - 60 minutes
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Exclusions

• 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

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Contacts
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HP Enterprise Services

• Toll-free in Arkansas [phone]
• Local or out-of-state [phone]
• Fax [phone]
• Monday-Friday (8 a.m. 5 p.m.)
• Medicaid Provider Enrollment Unit
• HP Enterprise Services
• PO Box 8105
• Little Rock, AR 72203-8105
• Fax [phone]

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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 [phone]
• Local or out-of-state [phone]
• Monday-Friday (8 a.m. 5 p.m.)

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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 Services Attn
Research Analyst PO Box 8036 Little Rock, AR
72203
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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 [phone] and entering their
extension.
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Contact Information
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Questions?