We make healthcare better.
We do this by making sure that the care provided equals the costs it takes to provide that care as part of our therapy review process. The therapy review department performs retrospective utilization and medical necessity reviews on speech, physical and occupational therapy provided to Arkansas’ Medicaid recipients under the age of 21.
PERFORMING PROVIDERSMedicaid services must be provided only by appropriately licensed individuals who are enrolled as Medicaid providers in keeping with the participation requirements in Section 201.000 of the Arkansas Medicaid Therapy Provider Manual. The qualified therapy practitioner who performs the therapy must be listed as the performing provider on the Medicaid claim. Section II-201.110 & 212.000
COMPLETION OF DMS 640 FORMExclusive use of the DMS 640 form will facilitate the process of obtaining referrals and prescriptions from the PCP or attending physician. A copy of the prescription must be maintained in the beneficiary’s records. The original prescription is to be maintained by the physician. Form DMS-640 must be used for the initial referral for evaluation and a separate DMS-640 is required for the prescription. After the initial referral using the form DMS-640 and initial prescription utilizing a separate form DMS-640, subsequent referrals and prescriptions for continued therapy may be made at the same time using the same DMS 640. Instructions for completion of form DMS-640 are located on the back of the form. View or print form DMS-640.
Question:“If the child has both Medicaid and private insurance and we (the provider) bill the insurance company but they apply the billed amount to the deductible, who pays for the child’s therapy? Do we (the provider) bill Medicaid because the insurance company didn’t pay or do we (the provider) bill a supplemental insurance source?”
Answer:“If a provider accepts both Medicaid and private insurance the provider would bill the amount to Medicaid and indicate any TPL on the claim. If there is no TPL then enter 0. The provider would need to have the documentation available for audit purposes that the insurance denied the claim or it went to deductible, etc.”
The providers may always call their EDS/HP representative if they have specific billing inquiries concerning the electronic or paper billing processes.
Find more answers in the Arkansas Medicaid Therapy Provider Manual Q&As.
DDS has provided a document that consists of FAQ for the Arkansas Early Intervention Comprehensive Data System. Click link to view.
Arkansas Medicaid Provider Manual Speech Therapy Revision Overview
Nov. 9, 2010
Please click on the audio player button to listen to the recorded session.
If you have further questions on specific reviews, please contact the Qsource Therapy Review Department at 501-801-6900 or email Jennifer Carger.