Personal Care FAQ’s

What do I need to send in for reconsideration?

A reconsideration request must be submitted within 35 calendar days from the date of the letter. If you disagree with the decision and you have further documentation to support admission/continuation, you may request reconsideration. A request for reconsideration, a copy of the approval/denial letter and additional supporting documentation must be submitted.

Where do I send the prior authorization/reconsideration request?

Prior Authorization/Reconsideration requests can be sent to:

ATTN: Personal Care
P.O. Box 180001
Fort Smith, AR 72918

Can I fax a prior authorization/reconsideration request?

Yes. A prior authorization request can be faxed to Attn: Personal Care at 479-573-7781. However, our fax machine will not send a delivery notification. Also, please be sure to put the number of pages (including the cover sheet) that you are faxing so that it can be verified that all pages are received.

How do I get a Medicaid number changed on a personal care prior authorization?

If you are unable to bill using the beneficiary’s new Medicaid number, complete the Medicaid number change form and fax it to 479-649-0776. Include the child’s old Medicaid number, new Medicaid number, and the prior authorization number(s) that will need to correspond with the new Medicaid number. An approval listing will be sent out to you with the next business day showing that the new Medicaid number has been linked to the prior authorization(s). Allow 48-72 hours before you start billing with the new Medicaid number.

What if a Medicaid beneficiary's name is changed during an authorization date range?

Please submit a request asking that the name be corrected. The request should include the beneficiary’s Medicaid number, the applicable prior authorization number, and documentation supporting the legal change of the beneficiary’s name.

What must be documented for alternate resources for assistance?

In-home personal care – The provider must consider other members of the client’s household as well as nearby relatives and friends. The documentation must indicate the usual times of their availability to assist the client and the frequency and duration of their assistance, and explain the circumstances of any individual household member’s inability to provide any assistance or to provide less than complete assistance with the client’s physical dependency needs.

In-school personal care – The provider must document the teacher to student ratio of the child’s classroom.

Can I request personal care as a total number of hours per day?

No. The frequency and duration of service of each personal care task that is to be provided must be documented.

If a child was authorized for two hours of personal care per day for six months, and, after three months it is determined that the child now needs three hours per day, what documentation must be submitted?

A revised personal care service plan signed by the child’s attending physician and documentation explaining why the increased time is required (this is usually for a deterioration in the child’s medical condition or a change in the child’s alternate resources for assistance.)

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