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Implementing a Change for the Better

Contents

Your Information Hub for the New MMIS

The Arkansas Department of Human Services (DHS) is pleased to announce the delivery of a new Arkansas Medicaid Management Information System (MMIS)! Arkansas Medicaid providers and beneficiaries rely on a MMIS for provider enrollment, beneficiary eligibility and claims processing. If you submit Arkansas Medicaid claims, they will be processed through this new system. The new MMIS will bring cutting-edge technology to DHS, Arkansas Medicaid providers and beneficiaries.

Check this page often for the latest alerts and important information regarding implementation and for opportunities to learn about the new MMIS. The more you know, the smoother your transition will be. The new MMIS and Healthcare Portal offer many features such as personalization and @neTouch to make your workflow effective, efficient and accurate. The success of the new MMIS depends on your satisfaction as an Arkansas Medicaid provider.

Immediate Notifications

Notifications at a Glance

Hospital Providers
Patient Control Number – 276 Transaction
MMIS FAQ Webinar
Claim Submission Cutoff
Primary Care Physician Provider Action Needed – Changing Service Counties/Regions
820 – Capitation Payment Report
Prior Authorization Requests
Electronic Data Interchange (EDI) Webinars
Rendering Provider Denials
RSPMI PA Denials
Legacy Portal
MC IDs/Old Submitter IDs
Rehabilitation Centers (RSPMI - Provider type 26 with specialty R6 - Rehabilitation Services for Mental Illness)
Hospice in Long Term Care Claims
Locating Your New Remittance Advices
Institutional Providers – Using NPI and Medicaid Provider ID Rather Than License Number
All Providers – Adjustment of a Paid Claim Request via 837 Transaction
Searching for Legacy MMIS claims in the Portal
Clarification of Trading Partner Linking
Transmission Upload via Portal
Processing Time Between Trading Partner ID Enrollment and EDI Submission
Claim Search
PES Submitters Acknowledgement
RSPMI Providers using Billing Vendors (RSPMI EDI – X12 Field BHT06)
Trading Partner – Referring Provider Update
Resolved Issues

Hospital Providers

Added 12/13/17
The Explanation of Benefit (EOB) were not active for crossover claims, which has caused issues during claims processing. This issue has caused the claims to suspend and subsequently not appear on your Remittance Advice statement. Both EOBs will be active the week of 12/18/17, all claims currently in suspense status will be recycled and should begin to appear the week of 12/25/2017.

  • EOB 0147 – Procedure/Revenue code missing or invalid
  • EOB 0152 – NDC/Procedure/Revenue Codes are not on file

Patient Control Number – 276 transaction

Added 12/12/17
If you are submitting a patient control number on 276 transactions, you must send the REF segment with a qualifier of “EJ” along with the patient control number. If you do not wish to indicate a patient control number, then you need to leave off this segment from your transaction. The REF segment with the patient control number is not a mandatory or required segment. However, if you send the REF segment with REF01=EJ and you leave off patient control number in REF02, this will cause a compliance error. Please get with your software vendor to ensure you are doing this correctly.

MMIS FAQ Webinar

Added 12/6/17
Please join DXC and AFMC for an upcoming MMIS frequently asked questions webinar. Get details and register today!

Claim Submission Cutoff

Updated 11/30/17
Claims must be submitted by 6:00 p.m. each Friday in order to be included in the weekly financial cycle. Your claims must be included in the financial cycle to pay the following week.

For Pharmacy claims processed by Magellan, the claims submission cutoff is midnight each Thursday.

Primary Care Physician Provider Action Needed – Changing Service Counties/Regions

Added 11/30/17
In an attempt to have the correct Primary Care Physician information on file, we are requesting that the PCP Agreement (Word, new window) be completed by PCPs who are changing service counties/regions or changing who will receive the Managed Care fee payment. Be mindful that if you remove a county/region and you have a patient currently assigned to you in that region, the patient will be unassigned. Please fax the form to (501) 374-0746.

820 – Capitation Payment Report

Added 11/21/17
We are aware of an issue that some providers have not received their 820 Capitation Payment report. We are working on a resolution at this time. Additional information concerning this issue will be posted here on Front Line and on the provider portal.

Prior Authorization Requests

Updated 11/16/17
Prior authorizations requests that should go to AFMC are being incorrectly entered into the HealthCare Provider Portal. These requests will not be processed through the portal and MUST go to AFMC for processing as usual. If you request your PA type through Beacon Health or AFMC, you will continue to use same process.

Only the following PA types are available on the portal:

  • 101 – Personal Care
  • 102 – Private Duty Nursing
  • 103 – Adult Dental
  • 104 – Child Dental
  • 105 – Orthodontics
  • 108 – Augmentative Communication Device Evaluation
  • 109 – Disposable Medical Supplies
  • 110 – Home Health Visit Extensions
  • 111 – Other prosthetics
  • 112 – Other medical service – use this process type for Hearing Services PAs
  • 114 – Specialized Service
  • 115 – IndependentChoices
  • 116 – Vision
  • 150 – DDS/ACS waiver
  • 151 – DDS services
  • 152 – Developmental Rehab Services
  • 153 – Title V
  • 154 – First Connections

Electronic Data Interchange (EDI) Webinars

Updated 11/15/17
The recorded EDI webinar from Wednesday, November 8 is available for replay. (HTML, new window)

View or print frequently asked questions from the recent webinars. (PDF, new window)

Rendering Provider Denials

Added 11/14/17
If you are experiencing denial for Rendering Provider NPI, check to see if one of these scenarios will resolve your issues:

  • A denial can occur if a provider’s NPI is not linked to their Arkansas Medicaid provider ID number. If you are receiving denials, then please complete the NPI reporting form (Word, new window), and fax it to DXC to create the link. Once your NPI and Medicaid ID have been linked, your claims can be resubmitted.
  • If your rendering provider does not have an NPI because they are not a “medical” provider (i.e., a teacher), then you would leave the rendering provider field blank. You must leave it blank in both the header and detail of the claim to bypass this edit.
  • RSPMI providers whose rendering providers have not yet enrolled have been given permission to leave both the header and detail blank to bypass this edit until their rendering providers have enrolled and their NPIs are linked.

RSPMI PA Denials

Added 11/14/17
The issue identified for RSPMI providers with claims denying for 399 – Prior Authorization not on file has been fixed. This is for RSPMI claims for revenue codes 0114, 0124, 0128, and 0129. These claims can now be resubmitted.

Legacy Portal

Added 11/14/17
WebRA on the legacy portal is now available to download your 10/26/17 RAs. To access WebRA, use your legacy provider portal login credentials. (HTML, new window)

MC IDs/Old Submitter IDs

Added 11/14/17
Many providers have been billing with PES using their old submitter ID (MC ID). You will NOT receive a response from PES if you are using your old submitter ID. Please validate you are using your new Trading Partner ID (TP01#) and not your former Submitter ID (MC0#) in the PES set-up Options Web Logon ID field pictured below:

Rehabilitation Centers (RSPMI - Provider type 26 with specialty R6 - Rehabilitation Services for Mental Illness)

Updated 11/13/17
Claims submitted and processed in the new Arkansas MMIS with rendering providers who are NOT enrolled in the Arkansas Medicaid program are denying for multiple Explanation of Benefits (EOBs) .

Current policy requires rendering providers to either be fully enrolled as a participating provider or as a registered, non-credentialed provider. If you have previously registered your participating provider, please make certain their NPI is on file with Arkansas Medicaid. To verify the status of their NPI, you may call Provider Enrollment at (800) 457-4454. Select option 0 for “Other Inquires” and then option 3 for “Provider Enrollment” when prompted.

To expedite payment until the rendering providers are enrolled or registered, RSPMI providers may remove the rendering provider ID/Name from the claim and resubmit. This will allow the claim to bypass the denials for rendering provider and give rendering providers time to submit their enrollment applications.

To prevent a duplicate claim denial for subsequent claims on the same date of service (DOS), all procedures provided on the same DOS to a single beneficiary must bill on a single claim detail line.

This workaround is for RSPMI ONLY. Outpatient Behavioral Health Services billing providers are expected to have their rendering providers enrolled and to complete the rendering provider field.

Hospice in Long Term Care Claims

Added 11/7/17
Hospice providers must put the facility ID in the correct facility field for hospice claims to price correctly when a member is in a LTC facility.

  • Web Portal: Enter the facility ID NPI in the Institutional Provider ID field.
  • PES: Enter the facility ID NPI in the Facility ID field.
  • EDI: Enter the facility ID NPI in Loop ID – 2310E Service Facility
  • Paper: Enter the facility ID NPI or MCD in field 78 Other.

Locating Your New Remittance Advices

Updated 11/6/17
Are you having trouble finding your RAs on the new HealthCare Provider Portal? There's a job aid to help! View or print the Search Payment History job aid. (PDF, new window)

When searching for RAs on the portal, providers should enter the Monday through Friday date range for that week’s RA. The Provider Portal uses the issuance date to locate the RA. If a provider receives a paper check, then the RA will be issued on a Thursday. If the provider receives EFT, the issuance date for the RA is Friday.

Institutional Providers – Using NPI and Medicaid Provider ID Rather Than License Number

Added 11/3/17
When submitting provider identification numbers in fields such as attending, operating, or facility ID, on an 837I electronic transaction providers must enter the NPI rather than a license number. For paper claims, the NPI or Medicaid Provider ID is acceptable but not a license number. If the claim is submitted with a license number in any of the provider ID fields as noted above the claim will be denied.

Note: The billing ID must always be an NPI on all institutional claims.

All Providers – Adjustment of a Paid Claim Request via 837 Transaction

Added 11/3/17
Electronic 837 transactions submitted for paid claim adjustments that contain ICNs from the Arkansas Legacy MMIS have erroneously denied for Explanation of Benefit (EOB) 1026 – Original ICN Not Present on 837 or Not Found in History. The DXC Technology team has corrected this issue and will be reprocessing. Please monitor future alerts for additional information on progress of this issue. Going forward, it is critical for providers to use the most current ICN when requesting paid claim adjustments or general inquiries.

Searching for Legacy MMIS claims in the Portal

Added 11/3/17
With the implementation of the new Arkansas MMIS claim-processing system, seven years of information on claims processed in Legacy MMIS were converted to the new Arkansas MMIS. Providers can access information on past claims through the new HealthCare Provider Portal. When logged into the Portal, delegates who have been assigned the Claim Inquiry function can navigate to Claims, select Search Criteria, and enter the relevant information to search for a claim.

Although claim information will be available in the Portal, claims processed in Legacy MMIS that were converted to New Arkansas MMIS will have new claim identification numbers (Claim IDs); the internal control numbers (ICNs) assigned by Legacy MMIS will not be used. Providers will not be able to search for claims processed in Legacy MMIS using the old ICNs. Other search criteria will be required to retrieve claim information. After a claim is identified in the new system, providers are encouraged to record the new Claim ID, as needed, for later reference. Use search criteria such as Beneficiary ID, Service ‘From and To’ and Claim Type in the Portal to find claims processed in Legacy MMIS that have been converted into the new Arkansas MMIS. Remember to use the most current ICN for the claim when requesting and adjustment or performing and inquiry.

Clarification of Trading Partner Linking

Updated 11/3/17
Providers should call the EDI Help Desk to request and consent to be linked to a given Trading Partner ID. DXC Technology must have a provider’s authorization to create a link between their Medicaid ID and their Trading Partners’ IDs.

Transmission Upload via Portal

Added 11/2/17
We are currently experiencing issues with EDI HIPAA Transaction files being uploaded via the Provider Portal. Until this issue is resolved, use the following Secure website (your trading Partner ID and password will allow you to connect to this site) to upload — https://fts.mmis.arkansas.gov (HTML, new window).

Note: this process is documented in the WebBBS File Transfer System (section 1.1.1) located on the Arkansas Medicaid website Documents for Vendors webpage in subsection “Other Vendor Resources.” View or print Trading Partner EDI File Submission Methods/Instructions. (Word, new window)

Processing Time Between Trading Partner ID Enrollment and EDI Submission

Added 10/31/17
When a Trading Partner enrolls for a new ID, there is a delay of up to five days before the Trading Partner ID is activated in the new MMIS. This delay enables staff to certify the trading partner’s file processing and ensure activation in multiple applications that support EDI file processing (standard HIPAA-compliant transaction files).

Claim Search

Added 10/27/17
If you are doing a claim search in the portal or through the Voice Response, you must use the most current Medicaid beneficiary ID number. If you are not certain that you have the current beneficiary ID number or you cannot locate a claim you know has been accepted, denied or suspended, then verify eligibility using the beneficiary’s name and date of birth. This search method will allow you to find the beneficiary’s most current ID number. You can then perform the claim search using the most current beneficiary Medicaid ID number.

PES Submitters Acknowledgement

Added 10/27/17
For submitters using PES, you will receive a 999 functional acknowledgement for all batch submissions.

RSPMI Providers using Billing Vendors
(RSPMI EDI – X12 Field BHT06)

Added 10/27/17
If you use a billing vendor, your claims may be misinterpreted in the new system causing them to DENY unless X12 field “BHT06” has the value “CH.”

In the legacy MMIS, some claims have processed with a value of “RP” in this field; however, this value will cause a denial in the new MMIS.

Please make certain your billing vendor knows the BHT06 field values:

  • RP = Report encounter
  • CH = Claim for payment

The legacy system translator does not consider field BHT06 when accepting claims. The new MMIS translator DOES consider field BHT06. This issue MUST be addressed immediately or your claims will be marked as encounters and will NOT PAY.

Trading Partner – Referring Provider Update

Added 10/26/17
This information pertains to trading partners – vendors, clearinghouses or billing companies. Providers who are aware of these types of denials should contact and refer their trading partners to this notification.

We are seeing a high HIPAA Compliance X12 failure rate for claims that require the Referring Provider. Both the First Name and the Last Name must be populated; some Trading Partners are leaving one field or the other blank. The following applies:

  • 837I – 2310F loop (Referring Provider First and Last Name must be populated)
  • 837P – 2310A loop (Referring Provider First and Last Name must be populated)
  • The qualifier in NM102 must be a 1 (Person) not a 2 (Organization)

Note 1: The Guides indicate it is supposed to be a person, but we understand that some are actually entities.
Note 2: The text in the fields is NOT examined; therefore, the contents can be whatever the Submitter determines is appropriate.

Ensuring both fields are populated will allow the claims to get past this compliance error. We are updating our Companion Guides to include this information as well.

Current Issue with Claims Submission

Added 11/3/17
This issue has been resolved.We are currently experiencing difficulty accepting claims that are submitted either by the Healthcare Provider Portal or PES. We are actively working this problem. Check back in an hour for updates.

Treatment History

Added 10/27/17
This issue has been resolved.We are aware of an issue that eligibility verifications are not providing the last date of service for procedure codes that have a benefit limit. For example, procedure code S0621 for a visual exam only allows one visual exam every 12 months. The eligibility verification under treatment history should provide the date of the last exam after entering the Medicaid beneficiary ID and procedure code. We are working to fix this issue now. If you need to know this type of information, please contact the Provider Assistance Center (PAC) and ask for the Tier 2 help desk.

ARKids First-B Copay

Added 10/26/17
This issue has been resolved.We are aware of the issue of eligibility verifications showing a $15 copay for ARKids First-B beneficiaries. The policy has not changed; the copay is still $10 and will be corrected.

PCP Verification

Added 10/26/17
This issue has been resolved. We are aware of an issue that Primary Care Provider (PCP) information is not available for some members on eligibility verifications. We are working on this now. In the meantime, please contact the Provider Assistance Center to assist you with the PCP information. Continue to do the eligibility verification to get your authorization to guarantee eligibility.

MMIS Job Aids

Training Materials File Name File Size
Eligibility Verification MMIS_JobAid_Eligibility.pdf 1.5MB
MAPIR MMIS_JobAid_MAPIR.pdf 1.2MB
Prior Authorization MMIS_JobAid_PriorAuthorization.pdf 2MB
Registering on the Provider Portal – Provider MMIS_JobAid_ProvPortalReg.pdf 6.1MB
Registering on the Provider Portal – Delegates MMIS_JobAid_DelegatePortalReg.pdf 4.4MB
Registering on the Provider Portal – Trading Partners MMIS_JobAid_TradingPartnerPortalReg.pdf 2.1MB
Frequently Asked Questions Regarding Registering on the Portal MMIS_JobAid_PortalRegFAQs.pdf 76k
Trading Partner ID Enrollment MMIS_JobAid_TrdngPrtnrIDEnroll.pdf 2.8MB
Frequently Asked Questions for Trading Partner ID Enrollment MMIS_TradingPartnerEnrollFAQ.pdf 75k
Search Payment History MMIS_JobAid_SearchPaymentHistory.pdf 946k
Submitting and Reviewing a Claim MMIS_JobAid_SubmittingReviewingClaim.pdf 3.4MB
Treatment History MMIS_JobAid_TreatmentHistory.pdf 1.5MB
Updating PCP Caseload MMIS_JobAid_UpdatingPCPCaseload.pdf 1.4MB
Uploading Documents MMIS_JobAid_UploadingDocuments.pdf 1.1MB
Using the new Medicaid Provider Portal PortalTraining.pdf 15MB

If you would like to learn more about the new MMIS, AFMC is hosting a series of webinars. View a webinar today!


Go to Arkansas Medicaid         dxc.technology

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