016.06.05 Ark. Code R. 036
Provider Manual | Transmittal Number |
Alternatives for Adults with Physical Disabilities Waiver........................................................... | 21 |
Ambulatory Surgical Center..................................................................................................... | 52 |
ARKids First-B......................................................................................................................... | 18 |
Certified Nurse-Midwife............................................................................................................ | 54 |
Child Health Management Services.......................................................................................... | 53 |
Child Health Services/Early and Periodic Screening, Diagnosis and Treatment....................... | 58 |
Children's Services Respite Care............................................................................................... | 7 |
Children's Services Targeted Case Management....................................................................... | 7 |
Chiropractic............................................................................................................................... | 50 |
DDS Alternative Community Services Waiver........................................................................... | 45 |
Dental........................................................................................................................................ | 71 |
Developmental Day Treatment Clinic Services........................................................ ......... | 56 |
Developmental Rehabilitation Services........................................................................... | 7 |
Domiciliary Care....................................................................................................................... | 37 |
ElderChoices Home and Community-Based 2176 Waiver..................................................... | 69 |
Federally Qualified Health Center............................................................................................. | 43 |
Hearing Services...................................................................................................................... | 47 |
Home Health........................................................................................................................... | 64 |
Hospice..................................................................................................................................... | 37 |
Hospital/End-Stage Renal Disease........................................................................................... | 69 |
Hyperalimentation.................................................................................................................... | 60 |
Inpatient Psychiatric Services for Under Age 21....................................................................... | 55 |
Licensed Mental Health Practitioners........................................................................................ | 39 |
Living Choices Assisted Living................................................................................................... | 7 |
Medicare/Medicaid Crossover Only.......................................................................................... | 33 |
Nurse Practitioner.................................................................................................................... | 47 |
Occupational, Physical, Speech Therapy Services................................................................... | 39 |
Personal Care.......................................................................................................................... | 60 |
Pharmacy.................................................................................................................................. | 69 |
Physician/Independent Lab/CRNA/Radiation Therapy Center.................................................. | 90 |
Podiatrist................................................................................................................................... | 48 |
Portable X-Ray Services.......................................................................................................... | 42 |
Private Duty Nursing Services................................................................................................ | .52 |
Prosthetics............................................................................................................................... | .62 |
Rehabilitative Hospital.............................................................................................................. | .46 |
Rehabilitative Services for Persons with Mental Illness........................................................... | .52 |
Rehabilitative Services for Persons with Physical Disabilities.................................................. | .27 |
Rehabilitative Services for Youth and Children....................................................................... | ...8 |
Rural Health Clinic Services..................................................................................................... | .43 |
School-Based Mental Health Services..................................................................................... | .12 |
Targeted Case Management.................................................................................................. | .47 |
Transportation.......................................................................................................................... | .62 |
Ventilator Equipment................................................................................................................ | .45 |
Visual Care.............................................................................................................................. | 57 |
Retroactive eligibility does not constitute an exception to the filing deadline policy. If an appeal or other administrative action delays an eligibility determination, the provider must submit the claim within the 12-month filing deadline. If the claim is denied for recipient ineligibility, the provider may resubmit the claim when the patient becomes eligible for the retroactive date(s) of service. Medicaid may then consider the claim for payment because the provider submitted the initial claim within the 12-month filing deadline and the denial was not the result of an error by the provider.
Occasionally the State Medicaid agency or a federal agency, such as the Social Security Administration, is unable to complete a Medicaid eligibility determination in time for service providers to file timely claims. Arkansas Medicaid's claims processing system is unable to accept a claim for services provided to an ineligible individual or to suspend that claim until the individual is retroactively eligible for the claim dates of service.
To resolve this dilemma, Arkansas Medicaid considers the pseudo recipient identification number 9999999999 to represent an "...error originating within (the) State's claims system." Therefore, a claim containing that number is a clean claim if it contains all other information necessary for correct processing.
By defining the initial timely filed claim as a clean claim denied because of agency processing error, we may allow the provider to refile the claim when the government agency completes the eligibility determination. With the claim, the provider must submit proof of the initial filing and a letter or other documentation sufficient to explain that administrative processes (such as determination of SSI eligibility) prevented the resubmittal before the filing deadline.
To submit a claim for services provided to a patient who is not yet eligible for Medicaid enter, on the claim form or on the electronic format, a pseudo Medicaid recipient identification number, 9999999999. Medicaid will deny the claim. Retain the denial or rejection for proof of timely filing if eligibility determination occurs more than 12 months after the date of service.
Providers have 12 months from the approval date of the patient's Medicaid eligibility to resubmit a clean claim after filing a pseudo claim. After the 12-month filing deadline (12 months from the Medicaid approval date) claims will be denied for timely filing and will not be paid. It is the responsibility of the provider to verify the eligibility approval date.
Any adjustment made by Medicare will not be automatically forwarded to Medicaid. If Medicare makes an adjustment that results in an overpayment or underpayment by Medicaid, the provider must submit an Adjustment Request Form (EDS-AR-004) with a copy of the appropriate red-lined crossover form reflecting Medicare's adjustment. Enter the Medicaid provider number and the patient's Medicaid identification number on the red-lined crossover form.
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016.06.05 Ark. Code R. 036