© Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Provider Enrollment 2014 HP - Fiscal Agent for the Arkansas Division of Medical Services

© Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. What’s New…. Application Fee Re-Enrollment Prescriber Enrollment

© Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 3 Application Fee On July 1, 2013, Arkansas Medicaid adopted new enrollment application fee requirements.

© Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 4

5 Providers Required to Pay Fee 05 – Hospital 06 – Autism Intensive Intervention Provider 07 – Pharmacy 09 – Independent Lab 10 – Independent Radiology 11 – Skilled Nursing Facility 13 – Intermediate Care Facility for the Mentally Retarded 14 – Home Health 15 – Transportation 16 – Prosthetic Services 21 – EPSDT 23 – Optical dispensing contractor 24 – Clinics 25 – Psychiatric facility—inpatient 26 – Rehabilitation center (RSPMI) 28 – Ambulatory Surgical Center 29 – Rural Health Clinic 32 – Personal Care 33 – Hyperalimentation 34 – Hemodialysis 35 – Family Planning 36 – Domiciliary Care 37 – Ventilator Equipment 38 – Private Duty Nursing 39 – Adult Denture Laboratory 45 – School based child health clinic 46 – Targeted Case Management 47 – Hospice 49 – Federally Qualified Health Center 50 – ElderChoices Home and Community based 2176 – chore services 51 – ElderChoices Home and Community based 2176 – adult family home 52 – ElderChoices Home and Community based 2176 – homemaker 53 – ElderChoices Home and Community based 2176 – home delivered meals 54 – ElderChoices Home and Community based 2176 – personal emergency response systems 55 – ElderChoices Home and Community based 2176 – adult day care 56 – ElderChoices Home and Community based 2176 – adult day health care 57 – ElderChoices Home and Community based 2176 – respite care 59 – School based hearing screener 60 – School based vision screener 61 – School based vision and hearing screener 63 – Targeted Case Management group 64 – Hospice physician group 65 – TCM organization/facility 66 – Hearing aids 67 – ACS Waiver Supportive Living/Respite/Supplemental Support 69 – AHEC – resident group 71 – ACS Waiver consultation service 72 – ACS Environmental Modifications Adaptive Equipment 73 – ACS Waiver specialized medical supplies 74 – ACS Waiver Case Management/Transitional Case Management/Community Transition 75 – ACS Waiver-Supported employment 76 – TCM/CS 77 – TCM/DCFS 78 – Developmental Rehabilitation Services 82 – ACS Waiver Organized Health Care Delivery System 84 – APD Environmental adaptations 85 – ACS Waiver Crisis Intervention 87 – IndependentChoices 88 – DYS/TCM organization and rehabilitative services for youth and children 89 – DYS/TCM organization and rehabilitative services for youth and children (RSYC) performing 90 – Children’s services/respite care 91 – School based mental health 92 – School district outreach for ARKids 93 – PACE 94 – Assisted Living 96 – ElderChoices Home and Community Based 2176 Waiver – Adult Companion Services 97 – APD, Agency Attendant Care 98 – APD, Counseling Case Management 99 – Benefit Arkansas and other

© Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 6 All Providers Who Must Pay The Application Fee Must Enroll Online

© Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 7 Paid the application fee to another state Medicaid program Paid Medicare The provider is not required to pay the application fee to Arkansas Medicaid if they have done either of the following:

© Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 8 The Application Fee: Is subject to change each year Must be paid by credit card, debit card, or electronic funds transfer Proof of payment must accompany the application

© Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 9 Pop Quiz If a provider is required to pay the application fee, how must they enroll?

© Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Re-enrollment

© Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 11 Arkansas Medicaid adopted new enrollment requirements. All providers will have to re-enroll every 5 years. Re-Enroll Every 5 Years

© Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 12 Re-enroll Every 5 Years A NOTICE WILL BE SENT BY MAIL 90, 60, and 30 DAYS BEFORE TIME TO RE-ENROLL

© Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 13 Enrollment Requirements INDIVIDUAL: W-9 forms Contract Disclosure Section IV-group affiliation Electronic Fund Transfer (EFT) Authorization for Automatic Deposit (optional) PCP agreement (if applicable) EPSDT agreement (if applicable) BUSINESS (all the above, plus:) Secretary Of State Letter (if applicable) SS4 for or Letter from IRS with tax id (if applicable) Change of ownership forms (if applicable)

© Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice uals/SectionV/Section_V.doc Documents and Agreements W-9 Tax form (DMS-652) Medicaid Provider Contract (DMS-652) PCP Agreement, if applicable (DMS See Section for PCP requirements.) EPSDT Agreement, if applicable (DMS-831. See Section of the EPSDT provider manual for the EPSDT Agreement.) Group Affiliation form, if applicable (DMS-652). This form is applicable for individual providers who choose to authorize a group to bill and receive reimbursement on their behalf.

© Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 15 Pop Quiz How often are providers required to re-enroll with Arkansas Medicaid?

© Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 16 Online Provider Enrollment

© Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 17 Go to Click on “Provider”

© Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 18 Can Can Delete

© Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 19

© Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 20 Prescriber Enrollment

© Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 21 Effective July 1, 2013, a new Federal regulation requires that prescribing providers must be enrolled in the state’s Medicaid program before a prescription can be paid by Medicaid.

© Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 22 Questions?

© Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 23 Thank you