Helping providers meet quality standards of care.
Health utilization management review
AFMC’s Fort Smith office provides health utilization management reviews for public and private health plans to ensure all health care services reimbursed are provided in the most efficient manner and are medically necessary. Review staff also help providers deliver the highest quality of care while at the same time preventing fraud and abuse.
- Child health management services
- Emergency room
- Concurrent inpatient review
- Retrospective review of inpatient admissions
- Reconsideration reviews
- Extension of benefits for outpatient, lab and imaging
- Medicaid Utilization Management Program
- Prosthetics and durable medical equipment
- Inpatient utilization management
- Solid organ and bone marrow transplant
- Medical necessity for surgical procedures and use of assistant surgeons
- Private peer review
- Web-based review through AFMC ReviewPoint® for inpatient continued stay
Find out more about AFMC’s Review Services.
In an effort to resolve claims denied for eligibility beginning with dates of service on 10/1/2013, Arkansas Medicaid has made modifications to bypass the timely filing edits. Claims are to be submitted electronically. Providers must verify that an eligibility segment for the dates of service in question is available on file, and verify that a PCP, if required, is on file before the claim is submitted. Providers will have an open window between October 17, 2016 and April 15, 2017 to submit claims. A listing of permissible reasons for qualifying claims and other pertinent information may be obtained from Medicaid. CLAIMS FILED BY PROVIDERS THAT DO NOT QUALIFY UNDER THE IDENTIFIED LISTING WILL BE REVIEWED AND RECOUPED.
AFMC and Medicaid hosted a timely filing webinar on Oct. 7. The webinar video and supporting materials are available at afmc.org/timelyfiling. Answers to questions asked during and after the webinar are also available.