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Provider relations

AFMC’s provider relations outreach specialists serve as the link between health care providers and Arkansas Medicaid. They help providers navigate the Medicaid system, updating providers on policy and procedures as well as providing tools to better assist in the care of patients.

General Medicaid

The provider relations outreach 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. They 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, the outreach specialists offer feedback and educational tools as needed to help providers implement quality utilization and improvement.

In addition to provider visits, the 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)

Arkansas Payment Improvement Initiative

The team educates providers on the requirements of the Arkansas Payment Improvement Initiative (APII). The initiative’s goals are to improve care while rewarding high-quality providers and creating a financial incentive for ineffective providers to improve. APII emphasizes care coordination, physician discretion and provider-led clinical decision making. The provider relations outreach team works in two APII areas: episodes of care (EOC) and patient-centered medical home (PCMH)

Episodes of Care

An EOC is the bundle of Arkansas Medicaid-covered health care services provided to treat a particular condition. EOCs are based on data from paid claims and data submitted through the Advanced Health Information Network (AHIN), which is the provider portal for quality metrics. Providers continue to submit claims and are reimbursed according to the established fee schedule. A principal accountable provider is identified for each episode and they are considered the provider who has the greatest potential to influence treatment decisions, cost, and quality of care.

Provider relations outreach specialists provide the following services for EOC:

  • Perform face-to-face visits with providers in the risk share based on historical and performance reports
  • Contact all other providers in the gain/risk share group
  • Educate providers on how episodes of care work and how to read reports and identify cost drivers
  • Assist with navigating the AHIN portal and how to enter quality metrics
  • Facilitate provider feedback to the state regarding episodes of care
  • Educate providers about upcoming episodes

Patient-Centered Medical Home

The Medicaid PCMH program builds on the Comprehensive Primary Care Initiative sponsored by the Centers for Medicare & Medicaid Services and complements EOC. The program rewards providers who meet defined metrics of care coordination, activities and transform their practices into PCMHs. The provider relations outreach team serves as a liaison between providers and Arkansas Medicaid’s PCMH vendor AFMC PCMH-PT, as well as assisting providers in the following areas:

  • Enrollment
  • Activity and metrics education
  • Frequently asked questions
  • Reading and understanding provider reports
  • AHIN portal education
  • Program feedback