Arkansas Administrative Code
Agency 016 - DEPARTMENT OF HUMAN SERVICES
Division 29 - Division of Medical Services
Rule 016.29.22-012 - Primary Care Case Management (PCCM) Reconciliation
Universal Citation: AR Admin Rules 016.29.22-012
Current through Register Vol. 49, No. 9, September, 2024
171.230 Primary Care Case Management Fee
A. In addition to reimbursing PCPs
on a fee for service basis for physician services, Arkansas Medicaid pays them
a monthly case management fee for each enrollee on their caseloads.
B. The amount due for each month is
determined by multiplying the established case management fee by the number of
enrollees on the PCP's caseload.
1. Medicaid
pays case management fees quarterly.
2. The accompanying Medicaid Remittance and
Status Report (RA) itemizes the payments and lists the number of enrollees and
each enrollment month.
3. Enrollees
are listed alphabetically by name, with their Medicaid identification numbers
and addresses also displayed.
C. PCP case management fees are paid
according to the PCP's direction. The PCP may choose to have the case
management fee paid to his or her individual provider ID number or to the group
provider ID number with whom the PCP is affiliated.
D. If the PCP's case management fees are paid
to a group and the PCP changes his or her affiliation, the PCP must submit a
new PCP Agreement Form to Provider Enrollment within thirty (30) calendar days
of changing affiliation. The PCP must also notify the beneficiaries on his or
her caseload of the change.
E. If a
PCP fails to submit a new PCP Agreement Form, the case management fees will pay
to the provider of record until a new PCP Agreement Form is received by
Provider Enrollment.
F. If a Group
Affiliation Form is received by Provider Enrollment to disassociate a PCP from
a group but the PCP Agreement Form is not received, the case management fees
will be paid to the individual PCP's provider ID number.
G. If a PCP's case management fees were paid
to a group in which the PCP is no longer affiliated, it is the responsibility
of that group to reimburse Medicaid the fees they were not entitled to
receive.
H.
No case
management fees will be back paid to a PCP who has failed to follow the process
described in Paragraph D of this Section.
I. Case management fees will be reconciled at
least quarterly, and may be reconciled at any time determined necessary to
resolve immediate issues.
Disclaimer: These regulations may not be the most recent version. Arkansas may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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