Provider relations – policy and education
IMPORTANT UPDATE!
Requests for Prior Authorization (PAs) and extensions of benefits (EOBs) must be submitted through the Medicaid Provider Portal instead of AFMC ReviewPoint, effective May 1, 2019. AFMC cannot receive or process PAs submitted through AFMC ReviewPoint after May 1, 2019.
Retrospective Reviews (for services that occurred in the past, excluding EOBs) will continue to be submitted through AFMC ReviewPoint.
To submit a PA through the Medicaid Provider Portal, you will need Medicaid Provider Portal login. From there, you can log in or register a new account. If you need immediate support, call (479) 649-8501. Please have your Medicaid Provider ID ready.
AFMC’s policy and education outreach specialists serve as the link between health care providers and Arkansas Medicaid. We help providers navigate the Medicaid system and stay up-to-date on policy and procedures.
Our team is a diverse group of professionals, each with several years of managerial experience in clinics and hospitals as well as home health experience and nursing. We visit the following types of providers:
- Primary care physicians
- Specialists
- Hospitals
- Area Health Education Centers (AHECs)
- Federally Qualified Health Centers (FQHCs)
- Rural health clinics
- Arkansas Department of Health clinics
During the visits, our outreach specialists offer feedback and educational tools as needed to help providers implement quality utilization and improvement.
Our team provides general consultation in the following areas:
- Medicaid, ARKids First B, and other waivered programs
- Medicaid policy updates and requirements
- Episodes of Care assistance and patient-centered medical home education to provide cost-effective, high quality care
- Emergency room education and in-service
- Non-emergency transportation education (NET services)
- Early and periodic screening, diagnosis and treatment (EPSDT)
See our map below to find an outreach specialist in your area.
Outreach Update Archive
- 20181010 Physician Selection and Change form updated - October 10, 2018
- 20181008 Arkansas Medicaid PCMH Enrollment - October 8, 2018
- 20180914 Behavioral Health Facility Closing October 12 - September 14, 2018
- 20180723 Arkansas Medicaid PCMH - Quarter 2 Reports - July 23, 2018
- 20180702 Retro Assignment:Newborns Voice Response System (VRS) - July 2, 2018
- 20180605 Change to Voice Response System (VRS) - June 5, 2018
- 20180531 PCMH HPB Selection Deadline - May 31, 2018
- 20180525 AHIN portal is now open - May 25, 2018
- 20180518 PCMH High Priority Beneficiary (HPB) Selection Deadline May 31 - May 18, 2018
- 20180328 PCMH HPB Selection Deadline March 31 - March 28, 2018
- 20180213 AFMC Outreach Update: MMIS Frequently Asked Questions - Feb 13, 2018
- 20180118 Changes for therapy providers - Jan 18, 2018
- 20180118 Arkansas Medicaid PCMH Enrollment Deadline Oct. 31 - Jan 18, 2018
- 20180118 AFMC Outreach Update: PCMH enrollment is now open - Jan 18, 2018
- 20171020 Arkansas Medicaid PCMH Enrollment Deadline Oct 31 - Oct 20, 2017
- 20170925 PCMH enrollment is now open - Sep 25, 2017
- 20170706 Changes for therapy providers effective July 2017 - July 6, 2017
- 20170622 Tobacco Cessation Coverage Program - June 22, 2017
- 20170424 Emergency Department Assessment and Treatment for Medicaid Patients - April 24, 2017
- 20160901 PCMH enrollment is now open - Sept 1, 2016
- 20160506 PCP Assignment Now Required - May 6, 2016
- 20160421 How iExchange Can Work For You - April 21, 2016
- 20160226 Episodes of Care Update - February 26, 2016
- 20150818 PCMH Open Enrollment - August 18, 2015
PCP update packets
2ND QUARTER, SFY 2019–2020 •OCT. 1 - DEC. 31, 2019
Download packet (PDF)
AHIN Updates
Episodes of Care
- SFY 2020 second quarter reports
- SFY 2020 second quarter episode of care reports can be viewed on AHIN on or after Oct. 31, 2019
EPSDT Reason Codes
- Primary care physicians (PCPs) are required to enter the applicable EPSDT reason code when submitting a claim for an EPSDT screening
- Specialists and providers delivering service as a result of a referral from an EPSDT screening should check the EPSDT box in the Medicaid portal, or choose “yes” under the EPSDT tab if billing through PES or an individual vendor
Exhausted Benefits
- Responsible provider for requesting extension of benefits: Medicaid Physician Manual, Section 220.000
Flu Vaccines
Hospital Emergency Department
MMIS
PASSE
- Beneficiary open enrollment dates: Oct. 1–31
- PASSE Beneficiary Support Line: 1-833-402-0672
- DMS-640 PCP Referral requirement for PASSE beneficiaries receiving school-based therapy services
- DHS Provider Call Center
- Contact Information: 1-888-889-6451 or passe.provider.questions@dhs.arkansas.gov
Patient-Centered Medical Home (PCMH)
- 2020 PCMH Enrollment dates: Oct. 1–Nov. 12
- Quarterly Reports
- Activities due by Dec. 31 – Pages 6, 11–16
- Care plans for high priority patients
- Patient literacy assessment tool
- Ability to receive patient feedback
- Care instructions for high priority patients
- 10-day follow up after an acute inpatient
- Developmental/behavior health assessment for children and adolescents
- Questions: pcmh@afmc.org
PCP Caseloads
- ConnectCare Caseload Maximum and PCP Caseload Limits: All Medicaid Manuals, Section 171.210
- PCP Patient Termination
Upcoming Conferences
- Arkansas Medicaid Educational Conference: Dec. 17, Embassy Suites Little Rock
- Division of Provider Services and Quality Assurance (DPSQA) Educational Conference: Dec. 18, Embassy Suites Little Rock
1ST QUARTER, SFY 2019–2020 • JULY 1 - SEPT. 30, 2019
Download packet (PDF)
Dual Eligibles
Dual eligible benefit plans having no Medicaid benefits
Episodes of Care
SFY 2020 first quarter reports
- SFY 2020 1st quarter episode of care reports can be viewed on AHIN on or after July 31, 2019.
Exhausted Benefits
- Responsible provider for requesting extension of benefits: Medicaid Physician Manual, Section 220.000
- Charges that are and aren’t the responsibility of the beneficiary: All Medicaid Manuals, Section 131.000 –132.000
MMIS
- Uploading Documents to the Portal Job Aid
- MMIS Provider 101 and upcoming events
- Upcoming MMIS workshops
PASSE
- DHS PASSE webpage
- PASSE Resource webpage
- PASSE contacts (including Care Coordination Supervisor contacts)
Patient-Centered Medical Home (PCMH)
- Webinar 6/21/19
- Quarterly Reports
- Questions: pcmh@afmc.org
Pharmacy
Magellan
- Contact Information: https://arkansas.magellanrx.com/provider/
- Go to the link above, and click “Contact Us” at the top of the page
- Drug look up: https://arkansas.magellanrx.com/provider/
- Go to the link above, and click “Tools” and then “Drug Lookup” at the top of the page
Provider Enrollment
- Needed documents for application
- Revalidation Webinar (November 2018)
- Checking application status via the portal (Go to Page 19 in the pdf.)
Therapy
- PCP Electronic Signature on DMS-640
- Medicaid Physician Manual: Section 203.210
- Medicaid OT, PT and ST Manual: Section 214.000
Voice Response System (VRS)
4TH QUARTER, SFY 2018–2019 • APRIL 1 - JUNE 30, 2019
Download packet (PDF)
Arkansas Works
DMS-2609 PCP Selection/Change Form
- PCP assignment not needed for IAPB or Medicare primary
Extension of Benefits
- Benefit Limits
- Prior Authorization Process
Immunization Schedule
Medicaid Management Information System (MMIS)
Medicaid Non-Emergency Transportation (NET)
PASSE
- NET for PASSE members
- PASSE choice counseling for members: 1-833-402-0674
- Tools for PASSE members and providers
PASSE Contacts
- DHS PASSE Provider Line………………………………1-888-889-6451
- Arkansas Total Care……………………………………….1-866-282-6280
- Empower Healthcare Solutions………………………..1-855-429-1028
- Summit Community Care………………………………..1-844-462-0022
Patient-Centered Medical Home (PCMH)
- HPB selection — Due April 12
- Population Health Management Report
- Quarterly Reports
- Addendum
- Manual
- Questions: pcmh@afmc.org
Physician Assistant — Direct Supervision
Provider Enrollment
Referrals
Telemedicine
Title V Children with Special Health Care
3RD QUARTER, SFY 2018–2019 • JANUARY 1 - MARCH 31, 2019
Download packet (PDF)
Arkansas Health Care Payment Improvement Initiative (AHCPII)
Episodes of Care
PCMH
Arkansas Works
New age range
Connect Care
- IABP: PCP assignment NOT required
Crosswalk
DMS-2609 PCP selection/change form
Dual eligible beneficiary
Extension of Benefits: Benefit Limit
No paper, no phone calls, no fax machines, secure submission
PASSE
Provider Handbook
Provider Enrollment
Needed documents for application
Referrals
Emergency department
1ST AND 2ND QUARTERS, SFY 2018–2019 • JULY 1–DEC 31, 2018
Download packet (PDF)
What’s New
Behavioral Health
- Informational report
- OBHS manual
- Referral change for primary care physicians
- Webinars – Stakeholder and transformation
Episodes of Care (EOC)
PASSE
PCMH News
- 12-month activities – Due by Dec. 31
- Open enrollment for 2019 performance period (Oct. 10–Nov. 21, 2018)
- Metric breakdown
- ADHD
- Asthma
- ODA
- PCMH updates webinar – Aug. 24, 2018
- Recorded webinars
- PBPM payment report
- Behavioral health pharmacy exclusion
Arkansas Health Care Payment Improvement Initiative (AHCPII)
Patient Centered Medical Home (PCMH)
Practice transformation
Episodes of Care
Links
- AFMC Service Center
- Beneficiary education
- Drug Lists
- Emergency Room
- EPSDT
- Learn on Demand
- Medicaid Management Information System (MMIS)
- Medicaid Policy
- Quality improvement project updates
- Review
- “What’s new” for providers
- Who may not enroll with a PCP
4TH QUARTER, SFY 2017–2018 • APRIL 1–JUNE 30, 2018
Download packet (PDF)
What’s New
Behavioral Health
- Informational report
- OBHS manual
- Referral change for primary care physicians
- Webinars – Stakeholder and transformation
Episodes of Care (EOC)
Fluoride
Medicaid Management Information System (MMIS)
- https://medicaid.mmis.arkansas.gov/Provider/frontline.html
- Aid Category to Benefit Plan Crosswalk
- AFMC MMIS Specialists Map
- Managed Care Capitation and Administrative Fees
- Eligibility Job+Aid
- Submitting and Reviewing a Claim Job+Aid
New URL for Arkansas Medicaid
PASSE
PCMH News
Remittance Advice (RA), March 22–29
Arkansas Health Care Payment Improvement Initiative (AHCPII)
Patient Centered Medical Home (PCMH)
Practice transformation
Episodes of Care
Links
- AFMC Service Center
- Beneficiary education
- Drug Lists
- Emergency Room
- EPSDT
- Learn on Demand
- Medicaid Policy
- Quality improvement project updates
- Review
- “What’s new” for providers
3RD QUARTER, SFY 2017–2018 • JANUARY 1–MARCH 31, 2018
Download packet (PDF)
What’s New
- Behavioral Health Transformation Webinar (Recorded Sept. 8)
- BreastCare
- ConnectCare Changes
- Electronic Funds Transfer (EFT): Action Required Now
- EPSDT Booklet
- Medicaid Management Information System (MMIS)
- New Crossover Form DMS-600
- PASSE
- PCMH News
- What’s Due?
- New to PCMH?
- PCMH Manual
- 2018 PCMH Program Policy Addendum
- Update/Change Form
- Questions? Contact PCMH@afmc.org
Arkansas Health Care Payment Improvement Initiative (AHCPII)
Patient Centered Medical Home (PCMH)
Practice transformation
Episodes of Care
Links
- AFMC Service Center
- Beneficiary education
- Drug Lists
- Emergency Room
- EPSDT
- Extension of Benefits Referral Forms
- Learn on Demand
- Medicaid Policy
- Non-Emergency Transportation Program (NET)
- Quality improvement project updates
- Referral Policy
- Review
- Voice Response System
- “What’s new” for providers
1ST AND 2ND QUARTERS, SFY 2017–2018 • JULY 1–DECEMBER 31, 2017
Download packet (PDF)
What’s New
- Behavioral Health Transformation Webinar (Recorded Sept. 8)
- ConnectCare changes
- Electronic Funds Transfer (EFT) Requirement Coming Soon
- EPSDT Booklet
- Extension of Benefits Referral Forms
- Medicaid Policy
- Medicaid Management Information System (MMIS)
- New Crossover Form DMS-600
- Non-Emergency Transportation Program (NET)
- PASSE Information
- PCMH News — What’s Due?
Arkansas Health Care Payment Improvement Initiative (AHCPII)
Patient Centered Medical Home (PCMH)
Practice transformation
Episodes of Care
Links
- AFMC Service Center
- Beneficiary education
- Drug Lists
- Emergency Room
- EPSDT
- Learn on Demand
- Patient termination: PCP transfers by PCP request
- PCP Assignment Required for Aid Category 06
- Quality improvement project updates
- Referral Policy
- Review
- Third party liability form (DCO-662 TPL) update
- Call 501-537-1070 for assistance with adding or deleting insurance from a Medicaid beneficiary
- Voice Response System
- “What’s new” for providers
4TH QUARTER, SFY 2016–2017 • APRIL 1–JUNE 31, 2017
Download packet (PDF)
What’s New
- Episodes of Care Update
- Extension of Benefits Referral Forms
- Medicaid Policy
- Medicaid Management Information System (MMIS)
- Non-Emergency Transportation Program (NET)
- PCMH News – What’s Due?
Arkansas Health Care Payment Improvement Initiative (AHCPII)
Patient Centered Medical Home (PCMH)
Practice transformation
Episodes of Care
Links
- AFMC Service Center
- Beneficiary education
- Drug Lists
- Emergency Room
- EPSDT
- Learn on Demand
- Patient termination: PCP transfers by PCP request
- PCP Assignment Required for Aid Category 06
- Quality improvement project updates
- Referral Policy
- Review
- Third party liability form (DCO-662 TPL) update
- Call 501-537-1070 for assistance with adding or deleting insurance from a Medicaid beneficiary
- Voice Response System
- “What’s new” for providers
3RD QUARTER, SFY 2016–2017 • JAN. 1–MAR. 31, 2017
Download packet (PDF)
What’s New
- Timely Filing Notice
- ADH Mumps Update
- AFMC Service Center
- ARKids First B Cost Sharing and Reimbursement
- Beneficiary Aid Categories
- Cough and Cold Drug List
- LARC Project
- Magellan Pharmacy Call Center
- New Medicaid Management Information System (MMIS)
- PCMH Deadlines – What’s Due?
- PCMH Policy
- Prior Authorizations
- Quick Reference Guide for Medicaid Eligibility
- ReviewPoint
- Update on Removal of 24-Day Hospital Cap
Arkansas Health Care Payment Improvement Initiative (AHCPII)
Patient Centered Medical Home (PCMH)
- PCMH 24/7 Best Practices
- PCMH Contacts
- PCMH FAQs
- PCMH manual and program policy addendum
- PCMH QA
- PCMH Recovery of Practice Support
- PCMH Research, Reconsideration and Appeals
Practice transformation
Episodes of Care
Links
- Beneficiary education
- Drug Lists
- Emergency Room
- EPSDT
- Learn on Demand
- Medicaid Pseudo Claims
- Outreach Update newsletter
- Patient termination: PCP transfers by PCP request
- PCP Assignment Required for Aid Category 06
- Quality improvement project updates
- Referral Policy
- Third party liability form (DCO-662 TPL) update
- Call 501-537-1070 for assistance with adding or deleting insurance from a Medicaid beneficiary
- Voice Response System
- “What’s new” for providers
2ND QUARTER, SFY 2016–2017 • OCT. 1–DEC. 31, 2016
Download packet (PDF)
What’s New
- Timely Filing Notice
- 2016-2017 Flu Update
- 2017 ICD-10 Billing Update
- Beneficiary Aid Categories
- Cough and Cold Drug List
- LARC Project
- PCMH Deadlines – What’s Due?
- PCMH Policy/Contacts
- Prior Authorizations
- Quick Reference Guide for Medicaid Eligibility
- Update on Removal of 24-Day Hospital Cap
Arkansas Health Care Payment Improvement Initiative (AHCPII)
Patient Centered Medical Home (PCMH)
Practice transformation
Episodes of Care
Links
- Beneficiary education
- Drug Lists
- Emergency Room
- Extension of Benefits (EOB)
- EPSDT
- Going Paperless
- Learn on Demand
- Medicaid Retroactive Eligibility
- Provider Outreach Update newsletter
- Patient termination: PCP transfers by PCP request
- PCP Assignment Required for Aid Category 06
- Quality improvement project updates
- Referral Policy
- Third party liability form (DCO-662 TPL) update
- Call 501-537-1070 for assistance with adding or deleting insurance from a Medicaid beneficiary
- Voice Response System
- “What’s new” for providers
1ST QUARTER, SFY 2016–2017 • JUL. 1–SEPT. 30, 2016
Download packet (PDF)
What’s New
- 24/7 Best Practices
- ER Flow Sheet
- Going Paperless
- Medicaid Educational Conference Presentations
- Medicaid Retroactive Eligibility
- PCP Assignment Required for Aid Category 06
- PCMH Deadlines — What’s Due?
- Voice Response System
Arkansas Health Care Payment Improvement Initiative (AHCPII)
Patient Centered Medical Home (PCMH)
Practice transformation
Episodes of Care
Links
- Beneficiary education
- Drug Lists
- ER Trend Reports
- Extension of Benefits (EOB)
- EPSDT
- Learn on Demand
- Provider Outreach Update newsletter
- Patient termination: PCP transfers by PCP request
- PCP Profile Reports
- Physician services benefit limit
- Quality improvement project updates
- Referral Policy
- Third party liability form (DCO-662 TPL) update
- Call 501-537-1070 for assistance with adding or deleting insurance from a Medicaid beneficiary
- “What’s new” for providers
Contact an outreach specialist
