If you submit claims on paper, use the CMS-1500, CMS-1450, or dental claim form. Arkansas Medicaid. If you submit claims without having reported your NPI, your claims will be denied with the error code “provider not on file.” Gainwell Technologies developed a reporting crosswalk tool to help providers communicate their National Provider Identifiers to Arkansas Medicaid. The Health Insurance Portability and Accountability Act (HIPAA) of 1996 requires the adoption of a standard unique identifier for health care providers. The health care provider Taxonomy code is a unique, 10-character, alphanumeric code that allows a provider to identify a specialty category. View or print Provider Enrollment contact information. The intent of the NPI is to eliminate the need for payers and providers to keep numerous identifiers and in turn simplify transaction processing between entities. To change your demographic information, submit an address change form. Yes, if a provider is required to get an NPI, it must be used on the claim for the billing, treating, referring, and attending providers. §455, Subpart B: Disclosure of Information by Providers and Fiscal Agents] DMS-2608 (Rev. Arkansas Medicaid Manual: CMS TARGETED CASE Page: MANAGEMENT Effective Date: 7-1-96 Subject: TABLE OF CONTENTS Revised Date: 8-1-01 SECTION CONTENTS PAGE 140 PROVIDER PARTICIPATION I-19 141 Provider Enrollment I-19 Provider Application – Form DMS-652 I-20 Medicare Verification Form I-23 If you are required to have an NPI for other transactions, you must also use it for billing claims. Data and Reports for Public Access. Divisions & Offices:Donaghey Plaza,P.O. National Plan and Provider Enumeration System (NPPES), https://www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/NationalProvIdentStand/efi, https://www.cms.gov/regulations-and-guidance/administrative-simplification/nationalprovidentstand, Go to the NPPES website to view or use the Registry. Provider Enrollment … Personal Care Response System. An individual provider may report their NPI independently. An individual or business that is not a health care provider and does not meet the definition of a health care provider according to the NPI Final Rule. You must contact Provider Enrollment to disassociate the rendering provider. If you are a typical provider, you are required to report your NPI to Gainwell Technologies. No, but you may fax the NPI Reporting Form to (501) 374-0746. Registering your NPI will only create a one-to-one match between the Arkansas Medicaid Provider ID and the NPI. New Provider Workshop Presentation. Some examples would be the billing, performing, requesting, attending, referring and prescribing provider number as appropriate for the transaction submitted. If a health care provider’s NPI is used in the case of fraud, a new NPI will be issued. The following are examples of subparts: Subparts do not apply to individual providers. The Final Rule for NPI requires a “covered entity” health care provider to get an NPI. P.O. Arkansas Medicaid will not bulk enumerate on behalf of its providers. In other words, rather than having a provider or group of providers submit a paper or Web NPI application, the EFIO obtains an NPI for them via the submission of an electronic file. In doing so, they have created a more user-friendly process that should save time for doctors, hospitals and other Medicaid providers. Examples are pest control, remodeling, chore services, non-emergency transportation providers, and so forth. Call the NPPES Enumerator at 1-800-465-3203. Yes. If providers have questions or need assistance with the online application, please contact the Arkansas Medicaid Provider Enrollment Office at (501) 376-2211 … The batch will be accepted, the individual claim with the missing NPI will not. What’s new for Arkansas Medicaid providers. More information on EFI can be found at. (Word, new window) Return to list. Data is available in two forms: The NPI Registry and downloadable data file are available at the NPPES website. No. If you are required to have a National Provider Identifier (NPI), you must report it to Arkansas Medicaid once enrolled as an Arkansas Medicaid provider. Ambetter offers affordable health care coverage for individuals and families. Yes, an atypical provider such as a non-emergency transportation provider may use electronic data interchange (EDI). Arkansas. No. State/ Territory State/Territory Provider Enrollment Web Site Link Contact Phone Number(s) Email AK Alaska Provider Enrollment AL. View Private Option/Arkansas Works quarterly and annual reports. Select option 0 for “Other inquiries” and then option 3 for “Provider Enrollment” when prompted. Provider Enrollment can be reached toll-free at (800) 457-4454 or local at (501) 376-2211. Gainwell Technologies will not offer a directory of NPIs; however, the National Provider Identifier (NPI) Registry is available now at the National Plan & Provider Enumeration System (NPPES) website. If you submit paper claims, you must use your Arkansas Medicaid Provider ID. If you have any questions or problems regarding your NPI, contact Provider Enrollment at (501) 376-2211 (local) or at (800) 457-4454 (toll free). Transportation is provided only to and from Medicaid-covered services. Provider Newsletter - Q2 2019 (PDF) Provider Newsletter - Q1 2019 (PDF) If a health care provider goes out of business, the NPI will be deactivated. The NPI is a 10-digit, intelligence-free numeric identifier (10-digit number). If providers have questions or need assistance with the online application, please contact the Arkansas Medicaid Provider Enrollment Office at … For billing related issues with your NPI, contact the Provider Assistance Center (PAC). Select option 0 for “Other inquiries” and then option 3 for “Provider Enrollment” when prompted. Using EDI does not determine if the provider is providing health care services or not. Before any NPI is reported the header will be Blue (not reported), an unsuccessful entry will be Red (conflict), and a successfully reported NPI will have a Green (Active) header. DME Compensation Schedule (PDF) Provider Newsletter. When a group logs into the NPI reporting crosswalk tool, all active rendering providers affiliated with the group are accessible under each group’s service locations. Additional information about the types of providers and subparts may be obtained from the CMS website or the NPPES website. What if you have Supplemental Security Income (SSI)? If you have any questions or problems regarding your NPI, contact Provider Enrollment at (501) 376-2211 (local) or at (800) 457-4454 (toll free). There is no cost to apply and providers may apply for an NPI in one of three ways: Providers must furnish any updates to the NPPES within 30 days of the change if any of the required data submitted on the application changes. If you have already reported your NPI number to Arkansas Medicaid, your NPI information has been successfully linked to your Arkansas Medicaid Provider number. Select option 0 for “Other inquiries” and then option 3 for “Provider Enrollment” when prompted or option 2 for “Provider Assistance Center” when prompted. Click the Enrollment Application link. Arkansas Medicaid requires all health care providers (individual, organization, and subparts of an organization) who provide health care services and submit electronic or paper claims to obtain an NPI. 7500 Security Boulevard, Baltimore, MD 21244. Yes. Arkansas Medicaid only accepts the National Provider Identifier (NPI) number anywhere a provider number is required on electronic transactions. Arkansas currently has the authority to rely upon provider screening that is performed by other State Medicaid Agencies (SMAs) and/or Medicare. Providers may have one or more Taxonomy codes associated to them. In order to link your NPI number with your Arkansas Medicaid provider ID, you must register your NPI with Arkansas Medicaid. 1-1-10) Affiliated provider listing available in the provider portal; Antigen testing Medicaid is a state and federal program that provides health insurance to people with low incomes. Only a provider can determine whether they need to apply for multiple IDs or subpart the provider’s organization. Using the Web-based NPI reporting crosswalk tool is quicker and more efficient. Arkansas Medicaid will only accept the National Provider Identifier (NPI) number anywhere a provider number is required on electronic transactions. Using Medicaid with Medicare or other Medical Insurance, ARKids – Additional Resources That Can Help Your Family, Important Phone Numbers for ARKids First Program, PASSE – Care Coordination and Person Centered Service Plan, National Provider Identifier (NPI) Information, Practitioner Identification Number (PIN) Frequently Asked Questions, What’s New for Arkansas Medicaid Providers, Arkansas Juvenile Assessment & Treatment Center (AJATC), Office of Legislative & Intergovernmental Affairs, Office of Communications & Community Engagement, Go to the NPPES website to view or use the NPI Registry, Go to the NPPES website to download the data file. For general information about NPI, see the CMS website and the NPPES website. The Arkansas Department of Human Services announced Tuesday it will delay for six months the initial open enrollment period for a new Medicaid … If a provider is required to report a Taxonomy code when using the Web-based NPI reporting crosswalk tool, only one Taxonomy can be chosen regardless of how many taxonomies were reported to NPPES. If you are interested in submitting claims electronically to Arkansas Medicaid please follow these enrollment instructions. Contact information is required only once for each time a user logs into the system to report NPIs. Provider Enrollment Wizard Tips. More information about NPPES Data Dissemination. Top 4 provider enrollment issues when applying on the portal. Using Medicaid with Medicare or other Medical Insurance, ARKids – Additional Resources That Can Help Your Family, Important Phone Numbers for ARKids First Program, PASSE – Care Coordination and Person Centered Service Plan, National Provider Identifier (NPI) Information, Practitioner Identification Number (PIN) Frequently Asked Questions, What’s New for Arkansas Medicaid Providers, Arkansas Juvenile Assessment & Treatment Center (AJATC), Office of Legislative & Intergovernmental Affairs, Office of Communications & Community Engagement, Become a Community & Employment Support (CES) Waiver Service Provider, Child Care Professional Development Registry, Community Services Licensure And Certification, resume work on an existing provider enrollment application, check the status of the application you submitted, pay the Medicaid provider enrollment application fee. Start a new online application. Arkansas Medicaid Manual: CMS RESPITE CARE Page: Effective Date: 7-1-96 Subject: TABLE OF CONTENTS Revised Date: 8-1-01 SECTION CONTENTS PAGE 140 PROVIDER PARTICIPATION I-19 141 Provider Enrollment I-19 Provider Application - Form DMS-652 I-20 Medicare Verification Form I-23 Electronic Fund Transfer (EFT) Letter I-34 If a physician is deceased, and electronic claims or adjustments will be submitted on his behalf after the NPI compliance deadline, an NPI must be reported for the physician. Arkansas Medicaid Provider Portal Application Required Documents October 2018 . Home > Become a Provider > Become a Medicaid Provider. In most cases no. Providers that are required to report their Taxonomy code in the NPI reporting crosswalk tool are also required to report their Taxonomy code on claims. Best is the online tool, since it will print an immediate receipt to confirm the proper reporting of your NPI. Employee Retirement Income Security Act (ERISA) plans, excluding some small self-administered health plans, Military Health System (for active duty and civilian personnel), Health care providers that choose to submit or receive electronic transactions, 06 Autism Specialty AV intensive intervention (group only), 06 Autism Specialty AX lead-line therapist, 06 Autism Specialty AZ clinical services specialist (group only), 15 Transportation Specialty TC non-public transportation, 15 Transportation Specialty TD NET transportation broker, 23 Specialty X2 optical dispensing contractor, 32 Personal Care Specialty P1 private care agency or health agency, 32 Personal Care Specialty PA Area Agency on Aging, 32 Personal Care Specialty PG level 1 assisted living, 32 Personal Care Specialty PS public school or education services, 32 Personal Care Specialty R3 residential care facility, 53 ARChoices Specialty E7 home delivered meals, 53 ARChoices Specialty EC frozen home delivered meals, 54 ARChoices personal emergency response systems, 70 Medicare Health Advantage Plan eligibility only, 72 ACS waiver environmental modifications—adaptive equipment, 73 ACS waiver specialized medical supplies, 82 ACS waiver organized health care delivery system, 86 non-Medicaid provider DDS non-Medicaid, 95 Registered, Noncredentialled Providers Specialty BP board certified behavior analyst paraprofessional, 95 Registered, Noncredentialled Providers Specialty CS community support staff, 95 Registered, Noncredentialled Providers Specialty NT qualified behavioral health provider (QBHP)/personal care aide/non credentialed, 95 Registered, Noncredentialled Providers Specialty NU resident, 95 Registered, Noncredentialled Providers Specialty NV physician assistant, 95 Registered, Noncredentialled Providers Specialty NW non-independently licensed clinicians, 95 Registered, Noncredentialled Providers Specialty RS certified peer recovery support specialist BH/SU, 97 Specialty AT ARChoices traditional agency attendant care, Providers may apply through an easy web-based application process at, The electronic file interchange (EFI) process, also referred to as “bulk enumeration”, allows a health care provider or group of providers to have a particular electronic file interchange organization (EFIO) apply for the NPI on their behalf. Medicare NPI policy and recommendations are available on the CMS website at https://www.cms.gov/regulations-and-guidance/administrative-simplification/nationalprovidentstand. A link to the Registry has been added to the “Provider information” menu for quick access from the Arkansas Medicaid website. You can only report your NPI and associate your Taxonomy codes using this tool. If you are not already participating in the Arkansas Medicaid dental program, you will need our provider enrollment packet and a Medicaid provider number. You can request a paper NPI Reporting Form to report your NPI. You can log back into the NPI reporting crosswalk tool at any time to report the NPI for providers. Yes. An atypical provider does not use an NPI; this type of provider must use the Arkansas Medicaid provider number on electronic claims. As a result, Arkansas is authorized to provisionally, temporarily enroll providers who are enrolled with another SMA or Medicare for the duration of the public health emergency. Contact us at 501-992-1710 and our friendly staff will help guide you through the process. Atypical providers must continue to use their Arkansas Medicaid provider ID. Some components or subparts of an organization may be eligible to obtain separate NPIs. If a health care provider is deceased, the NPI will be deactivated. CMS Health Care Independence Program Quarterly Reports. For Arkansas Medicaid, atypical providers include. Yes. Box 8105Little Rock, AR 72203-8105. Proceed by following the steps to report your NPI. Enrollment. A query-only database, known as the NPI Registry. Groups are allowed to obtain the NPI from their rendering providers and report it to Arkansas Medicaid on the rendering providers’ behalf. Home » Health care professionals » Arkansas Medicaid providers » MMIS Outreach Specialists » MMIS – Training » MMIS Provider Enrollment Revalidation Webinar – Nov. 8, 2018. Pharmacy providers can obtain a prescriber’s Medicaid ID number by logging on the Health Care Provider Portal. Arkansas Medicaid covers 27 percent of the state’s population. No. Medicaid 101 Presentation. Added 4/8/21 Go to the NPPES website to view or use the NPI Registry.Go to the NPPES website to download the data file.More information about NPPES Data Dissemination. To better serve the Kansas Medical Assistance Program (KMAP) providers during the COVID - 19 public health emergency, this page contains the latest information regarding the COVID - 19 changes being implemented by KMAP.. COVID - 19 Provider Information No. Provider Enrollment (800) 457-4454, in-state toll-free or (501) 376-2211 local and out-of-state Go to Provider Enrollment. For assistance reporting your NPI, please contact the Provider Enrollment Unit. No. The Registry allows you to search for providers’ NPI numbers. No. Enter your information and when you reach the question, “Are you currently enrolled as a Provider?” click yes, and then enter therovider ID. The federal government contractor hired to handle the NPI application and issue NPI numbers has not been given permission to release this information to Arkansas Medicaid or other payers. The provider’s NPI does not change and remains with the provider regardless of job or location changes. Box 1437, Little Rock, AR 72203, County Offices:Contact Your County Office, The Official Website of the State of Arkansas, Aging, Adult, & Behavioral Health Services, Find Substance Abuse or Mental Health Treatment, Find Home & Community Based Services for Adults & Seniors, Long-Term Services and Supports (LTSS) Medicaid Assistance, Agency Provider Certification for ARChoices in Homecare, Senior Community Service Employment Program, Challenging Your Background Check Results, Arkansas DHS Criminal Background Check Request Form, Financial Assistance and Resources for Providers, Report a Concern About a Child Care Center, Services for Older Youth or Former Foster Youth, Transitional Employment Assistance (TEA)/Work Pays, Title V: Children with Special Health Needs, Important Points About ARKids First and Medicaid. Arkansas Health & Wellness' plan is called Ambetter. It will not affect individual-group provider relationships. Provider Enrollment and Certification; Arkansas Arkansas State Name. Covered entities are further described as: With the exception of atypical providers, Arkansas Medicaid requires all health care providers (individual, organization, and subparts of an organization) submitting electronic claims to obtain an NPI. Gainwell Technologies will continue to identify providers that are not eligible for an NPI with their Arkansas Medicaid Provider ID. The NPI replaces health care provider identifiers in use today in HIPAA standard transactions. We serve participants in the Arkansas Medicaid The NPI must also be used on electronic eligibility verification transactions. Learn more about PASSE. The NPI is a single identification number assigned to health care providers. The NPPES also stores the information about enumerated providers. The following resources will help you understand and deal with the NPI and its impact on Arkansas Medicaid. Electronic billing has virtually eliminated the need for paper claims. Not all waiver providers are atypical providers. Some examples would be the billing, performing, requesting, attending, referring and prescribing provider number as appropriate for the transaction submitted. Box 1437, Slot S401Little Rock, AR 72203-1437, Divisions & Offices:Donaghey Plaza,P.O. What if you have Supplemental Security Income (SSI)? For pharmacy providers, “NP” is no longer accepted for the prescriber ID. Arkansas Medicaid will read only the NPI on claims unless the provider is atypical. The following is a list of situations that could occur for a covered entity with an NPI: NOTE: Deactivated NPIs will never be issued to other health care providers. Updating provider enrollment on status changes, section 141.000 of all Medicaid manuals. Arkansas Total Care is a Provider-Led Arkansas Shared Savings Entity (PASSE), a partnership between an insur ance payer, a provider group, and a specialty services provider. A “covered entity” is defined as a health care provider, clearinghouse or health plan who conducts standard electronic transactions. In an effort to work collaboratively with all our provider partners and the Arkansas Department of Health and Human Services, Arkansas Total Care has decided to delay these fee schedule changes until after April 1, 2021. Yes. In accordance with the e-FOIA Amendments, CMS has disclosed the data via the Internet. All providers, including relatives, are required to meet all ARChoices provider certification requirements, Arkansas Medicaid enrollment requirements and provide services according to the beneficiary’s PCSP and any established benefit limits for that specific service. DHS Division of Medical Services, Title XIX (Medicaid) [As required by 42 C.F.R. How do I determine if my rendering provider needs an NPI or a PIN? Be sure to get your NPI and report it to Arkansas Medicaid using the Web-based NPI reporting crosswalk tool. This white paper can be found on the WEDI website at http://www.wedi.org. If the NPI reporting crosswalk tool identifies a rendering provider that is no longer in your group, contact Provider Enrollment to disassociate the rendering provider. The NPI Final Rule issued January 23, 2004, adopted the NPI as this standard. Yes. Provider Enrollment. Select option 0 for “Other inquiries” and then option 3 for “Provider Enrollment” when prompted. Please note that your physical address could be used to help determine who you are when submitting claims electronically with your NPI, so make sure you verify the physical billing address we have on file for you. If you submit paper claims, you must use your Arkansas Medicaid Provider ID. If a provider wants to obtain an NPI, the provider is responsible for either applying directly for an NPI, or as part of another organization’s bulk enumeration process. Annual Billing Workshop Presentation. Arkansas Improvements to Medicaid Provider Enrollment Process. As required by HIPAA, the Secretary of Health and Human Services is adopting standards for the following administrative and financial health care transactions: Implementation Guides are available from the CMS website or from Washington Publishing Company. “Atypical” means non-traditional medical services. Since a non-emergency transportation provider cannot get an NPI, the current Arkansas Medicaid Provider ID must be used. In order to get an NPI, a provider must be a health care provider as defined under HIPAA. We work with the Arkansas Medicaid Program to help individuals with developmental disabilities or behavioral health needs keep track of their health and maintain their independence. We expect that a health care provider who submits a properly completed electronic application could have its NPI in 10 days.”. The provider will maintain the same NPI for life. When prompted, select 0 for “Other Inquiries,” then option 3 for “Provider Enrollment.” We’ve created a step-by-step video guide to walk you through the online provider enrollment process.You also can go online to re-enroll, resume work on an existing provider enrollment application, check the status of the application you submitted, and pay the Medicaid provider enrollment application fee. New Provider Manual Updates. Use only one method, either the paper form or the Web-based NPI reporting crosswalk tool. For more information about the NPI, view NPI frequently asked questions. Atypical providers conducting services like transportation or carpentry may not be considered health care services and therefore may be ineligible to get an NPI. (Word, new window) View or print changes to Form DMS-7708, Practitioner Identification Number Request Form. Providers who are not eligible for an NPI will continue to use their Arkansas Medicaid provider ID as always. You may reach Provider Enrollment or PAC by calling toll-free (800) 457-4454 or local (501) 376-2211. It is intended to improve the efficiency of the health care system and help to reduce fraud and abuse. Go to the NPPES website to view or use the Registry. DHS County Offices (HTML, new window) Healthcare Quality and Payment Policy Advisory Committee (HTML, new window) Report Problems With This Website. View or print the SecV-4-21 transmittal letter. Unless you plan to discontinue services at a location, every service location must have an NPI reported. Select option 0 for “Other inquiries” and then option 3 for “Provider Enrollment” when prompted. Health claims and equivalent encounter information, Health care payment and Remittance Advice, Required by Federal Regulations to have their own billing number. If the Medicaid Provider numbers were previously linked, registering the NPIs will not affect those linkages. Provider Enrollment Help and Information. No. New RA Messages. Information about NPI Application and Enumeration is available from the NPPES website. Tools and resources for provider … Providers II-3 200.120 Arkansas Medicaid Participation Requirements for Living Choices Assisted Living Agencies II-5 200.130 Arkansas Medicaid Participation Requirements for Living Choices Assisted Living Pharmacist Consultants II-8 200.200 Provider Staffing Requirements for … The Registry and the downloadable NPPES data file allow you to search for providers’ NPI numbers. NPI numbers for referring physicians or prescribers are necessary for electronic billing. Provider Enrollment can be reached toll-free at (800) 457-4454 or local at (501) 376-2211. No payment processing will be completed using the taxonomy code. The information you enter into the NPI Reporting Tool is updated in real-time for viewing data but in batch mode for claims processing. If you refer a patient to a physician who submits claims electronically, your NPI will be required to complete their claims. 2 Table of Contents ... tables to identify your Enrollment Type options, Provider Type Code, Provider Category and all of the documents you are required to submit with your application. To apply for an NPI through the Internet, go to the NPPES website. About Summit Community Care. If you fail to enter needed information, you will be prompted to provide the missing information. The Centers for Medicare & Medicaid Services (CMS) reported the following information on Medicare trends in Arkansas for the 2021 plan year: A … In each provider subsection of the NPI reporting crosswalk tool, the provider number (nine-digit number) displays in the green, red, or blue header, and the status of the provider/NPI record. Your Arkansas Medicaid provider ID may be given in the REF segment but your NPI will take precedence in our hierarchy. The NPI must also be used on electronic eligibility verification transactions. The Health Insurance Portability and Accountability Act (HIPAA) of 1996 requires the adoption of a standard unique identifier for health care providers. Provider Information. A typical health care provider must use a valid NPI on electronic claims. The Provider-led Arkansas Shared Savings Entity (PASSE) is a new model of organized care that will address the needs of certain Medicaid clients who have complex behavioral health and intellectual and developmental disabilities service needs. (HTML, new window) Return to list These “covered entities” must use the standards when conducting any of the defined transactions covered under HIPAA. Those identifiers include the Arkansas Medicaid provider number otherwise known as the legacy provider identifier (LPI) and Medicare legacy provider identifier such as the unique physician/provider identification number (UPIN); Online Survey, Certification, and Reporting (OSCAR); physician/provider identification number (PIN); and National Supplier Clearinghouse (NSC). Added 2/24/21 Arkansas Medicaid released a Section V all provider manuals update. Pharmacy providers must use the prescriber’s NPI number. Such factors include the volume of applications being processed at a given time, whether the application was submitted electronically or on paper, and whether the application was complete and passed all edits. If you have questions, contact Provider Enrollment toll-free at (800) 457-4454 or local at (501) 376-2211. Agenda. Under “Would you like to enroll as a Provider or a Trading Partner?” click the Provider link. If a user logs out of the system and logs back in, contact information will be required.
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