Provider relations – policy and education
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.
In addition to Medicaid provider manuals, official notices should be referenced for Medicaid program policy. - Arkansas Medicaid Official Notices
Educational Outreach Updates
- 20200521 Funding Resources for COVID-19
- 20200511 COVID-19 Resources
- 20200430 PCMH high-priority beneficiary selection for Arkansas Medicaid due April 30
- 20200427 PCMH high-priority beneficiary selection for Arkansas Medicaid due April 30
- 20200327 COVID-19 Resources
- 20200326 Arkansas Medicaid Division of Medical Services Telemedicine Requirements
- 20200323 Reminder - PCMH High-priority Beneficiary (HPB) selection ‒ Deadline March 31
- 20200319 ConnectCare Changes for PCP Assignment
- 20200319 Arkansas Medicaid Division of Medical Services Laboratory Testing Requirements
- 20200318 Arkansas Medicaid Telemedicine Requirements
- 20200310 PCMH High Priority Beneficiary (HPB) selection
- 20200212 2020 Medicaid PCMH High-priority Beneficiary Selection
- 20200131 Third-Party Liability
- 20200128 UPDATE – PCMH Quality Metrics and Informational Metrics Deadline Extended – February 28
- 20200124 PCMH Quality Metrics Tracked and Informational – Due – January 31, 2020
- 20200102 Medication Assisted Treatment (MAT) Update
- 20191112 Deadline Today! November 12 - Arkansas Medicaid PCMH Enrollment
- 20191108 Arkansas Medicaid PCMH Enrollment Reminder - Oct. 1 – Nov. 12
- 20191001 PASSE Open Enrollment October 1-31, 2019
- 20190924 Arkansas Medicaid PCMH Enrollment - Oct. 1 – Nov. 12
- 20190826 Non-Emergent ED Visits - PCP Referrals
- 20190807 EPSDT Reason Codes
- 20190711 Primary Care Services Rate Review Survey – Time Sensitive
PCP update packets
1ST QUARTER, SFY 2020–2021 • July 1 – Sept. 30, 2020
Download packet (PDF)
COVID-19 Response
DHS’s Response to COVID-19 for Beneficiaries
- How to apply for Medicaid services
- Frequently asked questions
- DHS contact information
- Additional topics being added as needed
DHS’s Response to COVID-19 for Providers
- Care Continuity Emergency Response Reimbursement Payments
- Hospital direct and non-direct care payments
- Laboratory/testing
- Medicaid provider/services requirements
- Pharmacy and medical devices
- Rural health centers and federally qualified health centers
Arkansas Medical Society
AFMC COVID-19 Updates and Resources for Providers
- Telehealth Payers Crosswalk
- Reduce the Impact of COVID-19 On Your Practice With Telehealth (Webinar)
- CMS Telehealth and Telemedicine Toolkit
- Additional topics available and being added as needed
Telehealth
Episodes of Care
- Reports
MMIS Medicaid 101 Webinars
Opioid Addiction Treatment Resources
- Opioid Addiction Treatment Resources
- Questions: Jennifer Shuler, MNSc, RN, APRN, ACNP-BC
Nurse Practitioner/Co-State Opioid Treatment Authority
501-396-6347
jennifer.shuler@dhs.arkansas.gov
Patient-centered Medical Home (PCMH)
- 2019–2020 PCMH Manual
- 2020 PCMH Program Policy Addendum
- Activities due by Dec. 31, 2020
- PCMH Update/Change form
- PCMH Withdrawal form
- PHMR Reconsideration Report
- PCMH Webinar 6/19/2020
- Questions: pcmh@afmc.org
PCP
Services not requiring a referral
PCP selection and change form
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 - Evidence-based Prescription Drug Program (PDL)
Go to the link above, and clinic “Resources” and then “Documents” at the top of the page - Evidence-based Prescription Drug Program Overview
- Preferred Drug List
- Prior Authorization Criteria
Provider Electronics Solutions (PES)
Sept. 1, 2020, Arkansas Medicaid will no longer accept claims through PES.
Smoking Cessation
- ARKids First-B Manual Section 222.750
- EPSDT Manual Sections 215.290, 242.100
- Nurse Practitioner Manual Sections 252.454
- Physician Manual Sections 257.000, 292.900
- Tobacco Cessation Programs:
https://arkansas.magellanrx.com/provider/
Go to the link above, and clinic “Resources” and then “Documents” at the top of the page - Coverage of tobacco cessation products as of Jan. 1, 2020
- Public Health Service (PHS) Guideline-Based Check List (Smoking Cessation Counseling Checklist)
What’s New
4TH QUARTER, SFY 2019–2020 • APR. 1–June 30, 2020
Download packet (PDF)
COVID-19 Response
DHS’s Response to COVID-19 for Beneficiaries
- How to apply for Medicaid services
- Frequently asked questions
- DHS contact information
- Additional topics being added as needed
DHS’s Response to COVID-19 for Providers
- Telemedicine Requirements for Physicians during the COVID-19 Public Health Emergency
- DMS Medicaid Provider Guidance on COVID-19 Laboratory Testing
- Prior Authorization Extensions during COVID-19 Outbreak
- Use of Telemedicine to Provide Occupational, Physical and Speech Therapy during COVID0-19 Outbreak
- Use of Telemedicine to Provide Occupational, Physical and Speech Therapy by licensed Assistants during COVID-19 Outbreak
- Telemedicine Requirements for Nurse Practitioners during the COVID-19 Public Health Emergency
- Suspension of 12 Visit Limit during the COVID-19 Public Health Emergency
- Additional topics available and being added as needed
AFMC COVID-19 Updates and Resources for Providers
- Telehealth Payers Crosswalk
- Reduce the Impact of COVID-19 On Your Practice With Telehealth (Webinar)
- CMS Telehealth and Telemedicine Toolkit
- Additional topics available and being added as needed
ARKids First-B
- Wellness screening periodicity schedule updates effective 1/1/2020
ARKids First-B Manual Sections 222.800 – 222.850 - Official Notice
Beneficiary Education Sessions
- April – June
https://afmc.org/individuals/arkansans-on-medicaid/beneficiary-education/beneficiary-education-training-sessions/
Episodes of Care
- Reports
- April episode of care reports can be viewed on AHIN on or after April 30, 2020
EPSDT
- EPSDT screening periodicity schedule updates effective 1/1/2020
EPSDT Manual Section 215.100 – 215.340 - Official Notice
Opioid Addiction Treatment Resources
- Opioid Addiction Treatment Resources
- Questions: Jennifer Shuler, MNSc, RN, APRN, ACNP-BC
Nurse Practitioner/Co-State Opioid Treatment Authority
501-396-6347
jennifer.shuler@dhs.arkansas.gov
Patient-centered Medical Home (PCMH)
- 2019 – 2020 PCMH Manual Addendum
https://www.paymentinitiative.org/pcmh-manual-and-additional-resources - 2020 PCMH Program Policy Addendum
https://www.paymentinitiative.org/pcmh-manual-and-additional-resources - Activities due by June 30, 2020
- 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
Smoking Cessation
- ARKids First-B Manual Section 222.750
- EPSDT Manual Sections 215.290, 242.100
- Nurse Practitioner Manual Sections 252.454
- Physician Manual Sections 257.000, 292.900
Third-party Liability
- When a Medicaid Beneficiary also has TPL
- TPL Unit: 501-537-1070
What’s New
3RD QUARTER, SFY 2019–2020 • JAN. 1–MARCH 31, 2020
Download packet (PDF)
ARKids First-B
- Wellness screening periodicity schedule updates effective 1/1/2020
ARKids First-B Manual Sections 222.800 – 222.850 - Official Notice
Beneficiary Education Sessions
- January – March
https://afmc.org/individuals/arkansans-on-medicaid/beneficiary-education/beneficiary-education-training-sessions/
Episodes of Care
- Reports
- January episode of care reports can be viewed on AHIN on or after Jan. 31, 2020
EPSDT
- EPSDT reason codes
- EPSDT screening periodicity schedule updates effective 1/1/2020
EPSDT Manual Section 215.100 – 215.340 - Official Notice
PASSE
Patient-centered Medical Home (PCMH)
- 2019 – 2020 PCMH Manual Addendum
https://www.paymentinitiative.org/pcmh-manual-and-additional-resources - 2020 PCMH Program Policy Addendum
https://www.paymentinitiative.org/pcmh-manual-and-additional-resources - Metrics due by Feb. 28, 2020
- Activities due by March 31, 2020
- Questions: pcmh@afmc.org
PCP Caseloads
- ConnectCare online PCP assignment process
- ConnectCare caseload maximum and PCP caseload limits: all Medicaid manuals, Section 171.210
- PCP patient termination
- PCP patient transfers by PCP request – all Medicaid manuals, Section 173.620
- Deceased patient removal process
Opioid Addiction Treatment Resources
- Medication Assisted Treatment (MAT) Arkansas Medicaid is removing the PA requirements for specific drugs used to treat opioid use disorder
- Steps to obtain Your MAT waiver
- Physician – https://pcssnow.org/medication-assisted-treatment/waiver-training-for-physicians/steps-to-obtain-your-mat-waiver-physicians/
- APN – https://pcssnow.org/medication-assisted-treatment/waiver-training-for-nurses/
- Physician Assistant – https://pcssnow.org/medication-assisted-treatment/waiver-training-for-pas/
- Mental health and addiction services in Arkansas
- Arkansas Community Mental Health Directory
https://humanservices.arkansas.gov/images/uploads/dbhs/CMHC_Directory_07022019.pdf - Narcansas – https://www.artakeback.org/narcansas/
- State-Targeted Response grant funded treatment facilities in Arkansas https://www.artakeback.org/substance-abuse-treatment/
- AR-IMPACT (Improving Multi-disciplinary Pain Care and Treatment) is a free program designed to help health care providers better manage their chronic pain patients and those who need their opioid dosage reduced. https://arimpact.uams.edu/
- MATRIARC (Medication Assisted Treatment Recovery Initiative for Arkansas Rural Communities) is a partnership with the Psychiatric Research Institute and the Arkansas Department of Human Services designed to expand evidence-based treatment for opioid use disorders. https://psychiatry.uams.edu/clinical-care/cast-2/matriarc/
- Project ECHO is part of MATRIARC, weekly video conferences available to community health centers needing assistance in opioid addiction treatment. Video conferences are held each Friday from noon to 1 p.m., with experts in addiction, therapy and case management discussing a variety of subjects related to opioid abuse. https://psychiatry.uams.edu/clinical-care/cast-2/project-echo/
- Questions:
Jennifer Shuler, MNSc, APRN, ACNP-BC, RN
Arkansas DHS Co-State Opiod Treatment Authority
501-396-6347
jennifer.shuler@dhs.arkansas.gov
What’s New
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
Contact an outreach specialist
Continuing to provide uninterrupted service to our clients is vital to us and ensuring the health and safety of our employees is critical. While our teams are working diligently to be available, we ask for your understanding as some questions may experience a slight delay in response time. Thank you for your patience as together we all work through the next few weeks to address the impact of COVID-19.
