2. Provider enrollment Claims processing Remittance Provider relations Medicaid Management Information System (MMIS) HP Enterprise Services Medicaid Fiscal Agent

3. Beneficiary Eligibility

4. 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 60 th post-partum day falls Beneficiary Eligibility

5. Verify Eligibility

6. 1.Go to www.medicaid.state.ar.uswww.medicaid.state.ar.us 2.Click on “Provider” 3.Click on “Log on” Log on

7. 4. Enter User ID and Password User ID 9-digit Medicaid ID number Initial password (will be prompted to change) For individual provider: SSN F or group/facility: Tax ID number Log on

8. 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

9. ---------------------------------------------- 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 number Trace number Beneficiary name as it appears with AR Medicaid Keyed ID number DOB listed with Medicaid 271 Request Response File Verifying Eligibility

10. ---------------------------------------------- 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 ELIGIBILITY 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 (continued next) Shows coverage TPL information Aid category Dates of eligibility County of residence Type of TPL Member number Policy number Group number Plan name Type of coverage Dates of coverage Name of insurer Company code Address 271 Request Response File Verifying Eligibility

11. (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 PROVIDER DATE TIME PERIOD: 01/01/2010 – 04/16/2010 LAST/ORG NAME:PCPLAST FIRST NAME:PCPFIRST NAME SUFFIX:MD TELEPHONE:5013746608 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: 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 File Verifying Eligibility

12. Up to 4 beneficiary eligibility segments with matching beneficiary IDs EPSDT screening information Medicare A and B effective dates Supplemental Eligibility Verifying Eligibility

15. 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

16. 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)

17. 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

18. 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 SATS Units

19. 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

20. Contacts

21. HP Enterprise Services Toll-free in Arkansas (800) 457-4454 Local or out-of-state (501) 376-2211 Fax(501) 374-0549 Monday-Friday (8 a.m. – 5 p.m.) Medicaid Provider Enrollment Unit: HP Enterprise Services PO Box 8105 Little Rock, AR 72203-8105 Fax: 501-374-0746

22. 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.)

23. 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

24. 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.

25. Contact Information

26. Questions?