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  • Ar Dms-2609 2018

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Middle Initial Medicaid ID# Social Security # Birth Date (mm/dd/yyyy) Mailing Address City State Zip Home Phone Cell Phone Email address Requested New Doctor (Primary Care Provider): I have pick.

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Prior authorization in health care is a requirement that a healthcare provider (such as your primary care physician or a hospital) gets approval from your insurance plan before prescribing you medication or doing a medical procedure.

Procedures can require authorization regardless of whether they are performed on an inpatient or outpatient basis. A registered nurse Clinical Services Specialist initially screens the prior authorization requests.

If you submit paper claims, you must use your Arkansas Medicaid Provider ID. Paper claims submitted with only an NPI will be returned for correction. If you submit claims on paper, use the CMS-1500, CMS-1450, or dental claim form.

The Administrative Simplification Compliance Act (ASCA) requires that Medicare claims be sent electronically unless certain exceptions are met. Providers meeting an ASCA exception may send their claims to Medicare on a paper claim form. (For more information regarding ASCA exceptions, refer to Chapter 24.)

What the law says – The Arkansas Medicaid Fraud False Claims Act imposes liability on people and corporations who knowingly submit false claims to the Arkansas Medicaid program.

If you have questions about how to enroll, call Arkansas Medicaid Provider Enrollment at (501) 376-2211 or toll free at (800) 457-4454. When prompted, select 0 for “Other Inquiries”, then option 3 for “Provider Enrollment”.

All submitted forms must be on standard paper claim forms. Standard claim forms can be purchased from authorized vendors.

Non-participating providers must submit Prior Authorization for all services. For non-participating providers, Join our Network.

Apply for Medicaid in Arkansas Eligibility: Children from 0-18 with incomes up to 211% of FPL; pregnant women with incomes up to 209% of FPL; parents with incomes up to 138% of FPL; non-elderly adults with household incomes up to 138% of FPL; certain elderly and disabled individuals.

Section 302.000 of the AR Medicaid manual defines timely claims. There are no exceptions to the 12-month filing deadline policy.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232