For your convenience, we've answered the questions we're asked most often. If you have a question about Arkansas Medicaid that isn't answered here, please get in touch with us.
Billing Policy Questions
- How can I be certain to receive my applicable manual updates, official notices, and RA messages by e-mail?
- What services are covered by Arkansas Medicaid?
- Is this patient eligible to receive Medicaid benefits?
- What procedure code do I use to bill Arkansas Medicaid for anesthesia on an Abdominal Hysterectomy?
- Which codes do hospitals use to file paper claims?
- Where can I get help completing a CMS-1500 claim form?
- Whom can I call with a question about a claim?
- Whom should I call for prior authorizations?
- Whom can I call about dental claims?
- Where can I order Medicaid forms?
- How long will it take to process my claim?
- Why was my claim denied?
- Who was responsible for my claim being denied?
- What do you mean that this procedure is "incidental?"
- Why won't Medicaid pay for an office visit and urinalysis?
- What is a claim "adjustment?"
- How can I reverse a claim that was sent this week?
- How can I recoup a paid claim and what happens to the ICN?
- If a patient has both Medicare and Medicaid coverage, how do I file the claim?
- This claim was denied for "timely filing." What does that mean?
Electronic Data Interchange (EDI) Questions
- Which beneficiary ID?
- I have questions about electronic billing. Is there someone I can talk to?
- How many digits are in a beneficiary's ID number?
- How can I sign up for electronic RAs?
- How do I access my WebRA?
- How long is my WebRA available?
- Can I opt out of WebRAs?
- Where can I find electronic rejection codes?
- What electronic and digital signatures will Arkansas Medicaid accept?
- How can I become an Arkansas Medicaid provider?
- How can I apply for a temporary Arkansas Medicaid provider number?
- How long does it take for my enrollment application to process?
- What are some tips for helping my provider application or re-enrollment progress more smoothly?
- What is deferred compensation?
Prescription Drug Questions
- How do I determine the correct unit and quantity when I bill Medicaid for this drug?
- Where may I see a list of the drugs covered by the Arkansas Medicaid program?
- This pharmacy claim was denied for "benefit limits." What does that mean?
Provider Portal Questions
- How can I change my PCP caseload?
- How can I change my demographic information?
- Why can't I access the provider information portal?
- What are the requirements for passwords on the provider information portal?
To be certain you receive your updates by e-mail:
- Ensure that you have chosen e-mail notification as your preferred media selection. This instructs us to send you applicable manual updates, official notices, and RA messages by e-mail instead of mailing you paper copies of these documents.
You can change your media selection by completing the Media Selection/E-mail Address Change Form. Return the form by mail to Provider Enrollment with an original signature.
- Be sure we have your current e-mail address on file.
We recommend a general e-mail account accessible by all billing staff to ensure that each provider stays up-to-date on Medicaid policies. For example, HealthCareBillers@healthcare.com instead of Suzy@healthcare.com.
Check with your Web provider or information technology department to set up a general e-mail account and then notify HP Enterprise Services of your new e-mail address using one of two forms. You can use the Media Selection/E-mail Address Change Form . Return the form by mail to Provider Enrollment with an original signature. Alternatively, you can use the Address Change Form to notify Provider Enrollment. This form requires an original signature for processing as well.
- Make sure your e-mail address will accept e-mail from hp.com
If you have not received e-mail from ARKCDTeam@hp.com in the past three months, your e-mail address may not currently accept mail from hp.com. Instruct your network administrator or e-mail provider to accept e-mails from “hp.com” Arkansas Medicaid sends e-mail in bulk, and some e-mail services may block bulk e-mail unless instructed otherwise.
Medicaid pays for a wide range of medical services. The Medical Assistance (Medicaid) Office assists in determining if Medicaid pays for a specific service. Many benefits have limits, especially for adults, which may be daily, weekly, monthly or annually. There are also services that have an overall dollar amount limit per time period. Some services require a referral from the beneficiaries’ PCPs. Services may be rendered by both private and public providers. All services, by definition or regulation, fall into one of the following groups:
- Mandatory Services
- Optional Services
- Waivers Approved by the Centers for Medicare and Medicaid Services (CMS)
NOTE: In addition to the services shown in these groups, the State complies with federal requirements regulating the EPSDT program. “Early and periodic screening and diagnosis and treatment” means:
- Screening and diagnostic services to determine physical or mental defects in recipients under age 21; and
- Health care, treatment, and other measures to correct or ameliorate any defects and chronic conditions discovered.
Is this patient eligible to receive Medicaid benefits?
Verify the patient's eligibility using your Medicaid software (PES), through the Provider Portal on this website, or by dialing the HP Enterprise Services Provider Assistance Center line and selecting option 3 for beneficiary eligibility. Beneficiary eligibility is determined by the local DHS offices and can be started or stopped anytime the beneficiary’s situation changes. Having a Medicaid ID card is not proof of eligibility and the responsibility of checking a beneficiary’s eligibility to receive Medicaid services lies with the Medicaid provider.
Code 00840 cannot be used when billing Arkansas Medicaid for anesthesia on an Abdominal Hysterectomy. Since there is no specific CPT code for Abdominal Hysterectomy at this time, code Z9940 should be used. When more than one anesthesia procedure is billed on the same date of service, documentation or a diagnosis code to justify the return to the operating room must be attached.
For hospitals that file paper claims, the only billing change following HIPAA has to do with local codes that are mapped to national codes. That is,
- Outpatient emergency claims must be billed with type of bill 101, regardless of whether the date of service is before 10/16/03 (procedure codes Z0646, Z0648, or Z0649) or after 10/13/03 (revenue codes 0450, 0622, or 0250). You may also use type of bill 131 and condition code 88 on a paper claim. If billed electronically, type of bill 131 with condition code 88 is payable.
- Inpatient paper claims may use new condition codes 80, 81, or 82. Inpatient paper claims also use condition codes AB, AN, or AX. Inpatient electronic claims should use condition codes 80, 81, or 82.
Both paper and electronic claims can use
- code 38 - Facility has semi-private rooms, but only private rooms are available (semi-private room not available) and
- code 39 - Facility only has private rooms (private room medically necessary).
Detailed billing instructions for your provider type can be found under “Billing Procedures” in Section II of your provider manual.
Call the Provider Assistance Center at one of the following numbers:
Local and out-of-state:
Whom should I call for prior authorizations?
Call the Arkansas Foundation for Medical Care at (800) 426-2234 (Arkansas) or (800) 824-7586 (out of state).
Whom can I call about dental claims?
Call Kathy Hatcher at (501) 374-6609, ext. 551.
Where can I order Medicaid forms?
To request forms, complete the Medicaid Form Request that can be found in Section V of your billing manual. View or print the Medicaid Form Request. When you have completed the form, you may fax it to 501-374-0549 or mail it to:HP Enterprise Services Forms Requests
PO Box 8034
Little Rock, AR 72203
How long will it take to process my claim?
HP Enterprise Services processes each week’s accumulations of claims during a weekend cycle. The deadline for each weekend cycle is midnight Friday. Claims transmitted electronically will appear on the RA within two weeks of transmission indicating paid, denied or pending. Paper claims may take as long as 30-45 days to process. HP Enterprise Services offers providers several options for electronic billing. Therefore, claims submitted on paper are lower priority and are paid once a month. The only claims exempt from this rule are those that require attachments or manual pricing.
We send you a Remittance Advice listing each of your claims. If a claim is denied, check the three-digit EOB code listed to the right of the claim on the RA. The EOB codes are explained on the last page of the RA.
Who was responsible for my claim being denied?
See Why was my claim denied above. EOB codes are explained on the last page of the RA. The explanation includes information about who was responsible for the denial.
What do you mean that this procedure is "incidental?"
Arkansas Medicaid considers the procedure to be part of another procedure for which a claim has already been filed. This item cannot be billed separately.
Why won't Medicaid pay for an office visit and urinalysis?
Arkansas Medicaid considers urinalysis to be "incidental to" (a part of) the office visit.
What is a claim "adjustment?"
After a claim is listed as paid on your remittance advice statement, it can be corrected if you realize that it contained an error. The error is corrected with an adjustment or reversal.
HP Enterprise Services first processes the adjustment, deducting the amount already paid for the claim from future claim payments. This cancels the incorrect claim.
Then HP Enterprise Services processes the attached claim for the correct amount.
Adjustments can be made electronically using PES software or by completing an Adjustment Request Form.
To complete an electronic adjustment or reversal:
- Open PES software.
- From the list, select the appropriate Claim Frequency code.
- Select 1 to submit an original claim.
- Select 7 to adjust a prior claim (indicated by the ICN). Copy the original claim, change the Claim Frequency to 7, type the 13-digit original ICN, correct the claim and save the transaction.
NOTE: You can adjust a claim only after it is listed as paid on a remittance advice. A claim cannot be adjusted during the week that it is originally submitted. The adjustment request must have the same details as the original claim. You cannot submit adjustment requests that add or delete details not submitted on the original claim. To remove a detail, you must recoup the claim and rebill. To add a detail, you must submit another claim with that detail.
- Select 8 to reverse (void) a prior claim (indicated by the ICN) and have the payment withheld from future payments.
NOTE: You must complete a voided claim exactly as it was originally submitted for the cancellation to be successful. You can increase your accuracy when voiding claims by copying the original claim, changing the Claim Frequency to 8, typing the 13-digit ICN, and saving the transaction.
To complete a paper adjustment:
- Complete an Adjustment Request Form for the claim. You can order this form from the Provider Assistance Center, or you can photocopy the example of the form in Section V of your provider manual. The form number is HP-AR-004.
- Complete a new paper claim form with the correct information. Attach it to the Adjustment Request Form. In the "Description" area of the Adjustment Request Form, note "Corrected claim is attached."
- Send the Adjustment Request Form with the corrected claim attached to:
HP Enterprise Services
PO BOX 8036
LITTLE ROCK AR 72203
You can reverse a claim using the claim frequency (or TOB) code "8 - void" and the original claim ICN. The reversal request must be an exact copy of the claim submitted. The reversal request can be sent until the adjudication cycle begins. The ICN will not appear on the remit the following week if the transaction was successful.
You can recoup a claim using the claim frequency (or TOB) code "8 - void" and the original claim ICN. The recoup request must be an exact copy of the claim submitted. The ICN on the remit the following week will be a region "54" and will appear on the denied adjustments sections.
If a patient has both Medicare and Medicaid coverage, how do I file the claim?
Bill Medicare first. Then,
- If the patient has only Medicare and Medicaid coverage and Medicare pays part of the claim (or applies the charge toward the deductible), bill the balance as a "crossover" claim through PES software. Or you can submit a paper crossover invoice (order this form from the Provider Assistance Center) to:
HP Enterprise Services
PO BOX 8034
LITTLE ROCK AR 72203
- If the patient has only Medicare and Medicaid coverage and Medicare denies the claim, bill the charges to Medicaid on an original red-ink claim form (CMS-1500 or CMS-1450), attaching the Medicare denial. Submit the claim to:
HP Enterprise Services
PO BOX 8036
LITTLE ROCK AR 72203
If Medicare denies the claim and the patient also has Medicare-supplement or
private insurance, bill the charges to Medicaid on an original red-ink
claim form (CMS-1500 or CMS-1450), attaching both the Medicare denial and the
insurance company's Explanation of Benefits form. Submit the claim to the HP
Enterprise Services research analyst as shown above.
If Medicare pays the claim but Medicare-supplement or private insurance denies
it, bill the claim to Arkansas Medicaid on the paper crossover invoice,
attaching the insurance company's denial. Submit the claim to the HP Enterprise
Services research analyst as shown above.
- If both Medicare and Medicare-supplement or private insurance deny the claim, then bill the charges to Medicaid on an original red-ink claim form (CMS-1500 or CMS-1450), attaching both denials. Submit the claim to the HP Enterprise Services research analyst as shown above.
This pharmacy claim was denied for "timely filing." What does that mean?
Arkansas Medicaid pays claims that are received within 12 months of the date of service.
Arkansas Medicaid may have more than one beneficiary ID on record for any given Medicaid patient. The base ID--the beneficiary’s original Medicaid number--remains in the data processing system permanently. If the beneficiary’s eligibility for Medicaid services has not been continuous, then that beneficiary may also have multiple IDs that are different from the base ID. Any of these ID numbers can be used to verify eligibility and file claims.
Prior to HIPAA, no matter what ID number was submitted on an eligibility-verification request, the system response showed the beneficiary’s base ID, sometimes creating confusion. Since October 31, 2003, the response shows the same ID number that was submitted by the provider. The response to a “fuzzy search” based on the beneficiary’s name shows the base ID.
I have questions about electronic billing. Is there someone I can talk to?
If you have questions or problems related to electronic claims, please see PES trouble-shooting notes, and then call the HP Enterprise Services EDI Support Center if necessary.
Please note: If you need assistance installing PES on your network or resolving transmission problems when using PES on your network, you will need to contact the technical support representative or team in your office. EDI does not support network issues.
Local and out-of-state:
Providers who file electronic claims can report “Host Processing Error,” “Unable to Assign ICN” or “Server is Down” messages during off hours by calling the HP Enterprise Services EDI Help Desk at (501) 374-6609, ext. 290. This number is available Monday through Friday, 5 pm to 8 am, and on weekends and holidays. Leave a message, and Help Desk personnel will be paged immediately. If you do not leave a message, no problem report will be registered. Do not use this number to report claim rejections.
How many digits are in a beneficiary's ID number?
If you are receiving web or paper RAs, you can sign up at any time for electronic RAs (835 transactions). Simply email HP Enterprise Services EDI Support Center at firstname.lastname@example.org and ask to receive 835 transactions. You will need to include your Submitter ID (MC number) and the Arkansas Medicaid Provider number(s) that you want to receive the 835 transaction(s). Your files will be created over the next week or so. After that, you can download 835s via PES or Web BBS.
- The 835 is tied to only one submitter ID (MC number).
- The 835 can be picked up only once. If you have more than one biller, assign an individual to pick up the 835 each week and share the information with others who are affected. (If you have trouble downloading the file or you accidentally delete the file--or any other response file--contact the EDI Support Center for assistance.) The 835 is only available for 30 days after the creation date and cannot be recreated or reposted after that time.
Log on to the Arkansas Medicaid provider portal, click the WebRA link in the left-hand menu and then follow the instructions to register each of your provider numbers. If you previously opted out by completing an Application for WebRA Hardship Waiver, you can also use the WebRA link to switch back to WebRA at any time.
WebRAs are maintained for 35 days to provide the most recent five weeks of PDF RAs online. Providers are encouraged to download and save an electronic copy of the PDF RAs to their hard drive. After the 35 days, PDF RAs will no longer be available. If you require a copy of an RA that is no longer available in WebRA, call the Provider Assistance Center (PAC) to obtain a paper copy. Standard fees of 25 cents per page apply. You can reach PAC by calling (800) 457-4454 in-state toll-free or (501) 376-2211 local and out-of-state. Select option 0 for "Other inquiries" and then option 2 for "Provider Assistance Center" when prompted.
With the exception of Alternatives for Adults with Physical Disabilities (APD) providers, all new providers are automatically enrolled in WebRA. To opt out of WebRA, you must complete an Application for WebRA Hardship Waiver. (Please note: If you previously opted out by completing an Application for WebRA Hardship Waiver, you can log on to the Arkansas Medicaid provider portal and use the WebRA link to switch back to WebRA at any time.)
Where can I find electronic rejection codes?
These codes are included in the HIPAA Companion Guides.
The approved electronic and digital methods are indicated below.
- ePadlink electronic signature pad,
- Topaz Systems, Inc. electronic signature pad,
- any digital signature currently issued by the Arkansas State Certificate Authority (provided by DHS), or
- any digital signature verifiable against a current certificate authority accepted by the Microsoft Windows certificate program (http://support.microsoft.com/kb/931125).
How can I become an Arkansas Medicaid provider?
To enroll as an Arkansas Medicaid provider, you will need to submit an application and contract. To access the online application, select "Start an application" from the "Enrollment" section in the navigation bar on the left of your screen. You can also apply by filling out a paper application. Section V of each provider manual includes a link to the Provider Enrollment Application and Contract Package. View or print an application and contract.
If you have questions about how to enroll, call Arkansas Medicaid Provider Enrollment at (501) 376-2211 (local or out of state) or (800) 457-4454 (Arkansas). When prompted, select 0 for "Other Inquiries", then option 3 for "Provider Enrollment". View or print Provider Enrollment contact information.
The links above open Microsoft Word documents (.doc). When you click the link, the document opens in a new window. To return to this page, close the window. If you click the link and the document doesn't open, download Microsoft Word Viewer free so you can view and print the document.
If you are required to have a National Provider Identifier (NPI), you must report it to Arkansas Medicaid once enrolled as an Arkansas Medicaid provider. For more information about the NPI, view NPI frequently asked questions.
Arkansas Medicaid does not issue temporary provider numbers. To obtain an Arkansas Medicaid provider ID number, you must complete an application for enrollment. See How can I become an Arkansas Medicaid provider?
The application process can take 30 business days. Delays with your application can occur if it contains incomplete or incorrect items. When applying online, there is less possibility for making errors that would result in your application being denied and returned to you for correction. If you fail to enter needed information, you will be prompted to provide the missing information.
The Provider Enrollment Unit will return incomplete and incorrect applications by mail with a denial letter. You should complete or correct the application as instructed in the denial letter and return the entire application to the Provider Enrollment Unit.
Our enrollment specialists have listed some tips to help your application or re-enrollment progress more smoothly.
- Some parts of the enrollment application must be mailed or delivered to Provider Enrollment. No faxes or photocopies will be accepted for these items. Original signatures are required on these documents:
- W-9 forms
- Section IV-group affiliation
- Electronic Fund Transfer (EFT) Authorization for Automatic Deposit
- Name change forms
- Change of ownership forms
- Address change forms
- You must submit credentials annually. A good rule of thumb is to fax a current copy to Provider Enrollment when you mail your license/certification renewal fees to your state. When faxing state licenses, please make certain you fax the current license. Always check the expiration date before faxing.
- When submitting credentials for re-enrollment, always write your provider number on the form. This will help us process your renewal more quickly if there are several providers under the same tax ID number.
- When enrolling for Electronic Fund Transfer (EFT) Authorization for Automatic Deposit, you must attach a voided check or a letter from the bank. Deposit slips are not accepted to set up EFTs.
- If you have been inactive with Arkansas Medicaid for 6 months, you must submit a new application.
- W-9 forms and contracts for individual providers must be submitted in their name, with their Social Security number, and their original signature. If the W-9 or contract is for a group or facility, it must include the tax ID number and an original signature. A tax coupon is also acceptable in place of a W-9 form.
As a Medicaid provider, you are an independent contractor of the state of Arkansas and are eligible to defer a portion of your Medicaid income on a pre-tax basis. By making contributions to the State of Arkansas Diamond Deferred Compensation 457(b) Plan, commonly referred to as the Arkansas Diamond Plan, you can include Medicaid as an element of your retirement planning.
The annual dollar limit is $18,000 for calendar year 2015. If you are age 50 or older, the catch-up contribution annual dollar limit is $6,000 for calendar year 2015. This deferral is in addition to any contributions made on your behalf to a qualified retirement plan established by your group or individual practice such as a 401 (k) plan, a profit sharing plan, a money purchase pension plan or a defined benefit plan. The Arkansas Diamond Plan includes a special pre-retirement catch-up provision which allows deferrals for three consecutive years. The 3-year, pre-retirement, catch up will be $36,000 in 2015. The Arkansas Diamond Plan also offers a ROTH option. Participants can utilize both options during the year if they wish, but their total contribution cannot exceed their respective calendar year limit.
For more information regarding the Plan, eligibility requirements, and investment options, contact Robert Jones of Stephens, Inc. at 501-377-8112 or 1-866-275-0457.
How do I determine the correct unit and quantity when I bill Medicaid for this drug?
All products are billed as milliliter(s), gram(s), or each.
- Most liquids are billed in milliliters. And products containing powder for reconstitution to be taken orally are billed in milliliters following reconstitution.
- Most ointments, creams, and topical powders are billed in grams.
- Most tablets or capsules are billed as each. Vials containing powder for reconstitution to be injected are billed by the number of vials--each. Other items that normally are billed as each are blood factor units, kits, packets, syringes, condoms, and diaphragms.
Each (1 inhaler is billed as a quantity of 1)
Each (per kit)
Milliliters (example – Lovenox 60mg/0.6ml syringe is billed as a quantity of 0.6 per syringe)
Each (per unit) (revised per NDCPDP – 112 units per kit)
Grams (example – Ventolin 18 gram inhaler is billed as a quantity of 18)
Where may I see a list of the drugs covered by the Arkansas Medicaid program?
It is not feasible for Arkansas Medicaid to maintain a complete, current list of covered drugs because new products are released so frequently. However, the agency provides guidelines for determining what products are payable. Coverage of any product depends on the manufacturer's or labeler's participation in the federal rebate program administered by the Centers for Medicare and Medicaid Services. The Arkansas Medicaid Pharmacy Provider Manual defines the scope of coverage in Section II. Several other factors affecting coverage and limitations of payment for drugs, previously listed in Section V, are now available at the web. View prescription drug information on the web. You can download the Pharmacy Provider Manual free.
This pharmacy claim was denied for "benefit limits." What does that mean?
Arkansas Medicaid's claim records show either that the beneficiary already received all prescriptions allowed for the month or that all refills allowed for the prescription already have been made.
Providers can now change their patient caseloads online at the Arkansas Medicaid website utilizing the Provider Information Portal. To set the PCP caseload over 2500, Provider Enrollment requires a written request stating why the higher caseload is needed. The request should be mailed to:Medicaid Provider Enrollment Unit
HP Enterprise Services P.O. Box 8105
Little Rock, AR 72203-8105
No faxes or photocopies will be accepted. An original signature is required on the request. If the PCP caseload is set over 2500 using the online form, an error will be reported and no change will be made.
Non-facility providers can change their demographic information online after they have logged onto the provider information portal.
Only currently active providers have access to the provider information portal. Inactive or suspended providers must contact the Provider Enrollment Unit before they will be able to log on the portal.
There is only one password per provider number. This information should be given to individuals who need access to the provider information portal for checking eligibility or submitting claims. Providers are encouraged to designate one primary account holder to maintain their provider portal account. Security question answers should only be given to the primary account holder in the event that they need access to change or reset security credentials. The current password and security question answer are required to change or update an account's security credentials.
HIPAA requirements mandate the following security measures for the provider information portal:
- Users will be automatically directed to change their password if it matches their Tax ID/SSN or Medicaid/BreastCare provider ID.
- Passwords must meet all of the password requirements for the provider portal.
- Users must select a security question and provide an answer to that question to be used later to unlock the account or recover a password.
- Security question answers must:
- Be at least 4 characters long
- NOT contain the user ID
- NOT contain the security question
- Users will be redirected to the log-on page if there is no activity on a secure page for more than 20 minutes.
- Users will be locked out of an account automatically after six failed log in attempts within an hour. To unlock an account, users should follow the Provider Portal Password Self-Help Guidelines. (PDF, new window)
- Users can change a Provider Portal password through the “My Information” menu.
For assistance with your Provider Portal password, view the Provider Portal Password Self-Help Guidelines. (PDF, new window)
Passwords for the Provider Portal must adhere to specific requirements. All passwords are case sensitive and must:
- Be between 8 and 20 characters in length
- Contain at least 1 alpha character
- Contain at least 1 numeric character
- Contain at least 1 uppercase character
- Contain at least 1 lowercase character
- Contain at least 1 special character
- NOT contain the same character more than twice
- NOT contain the user ID
- NOT be any of the previous 6 passwords