Medical Billing in Arkansas

What is specific to Arkansas

Arkansas covers much of its expansion population through ARHOME, which buys qualified health plan coverage from commercial carriers, so those members carry a commercial plan card alongside their Medicaid eligibility.

Arkansas’s Medicaid programme is Arkansas Medicaid. Practices with a meaningful Arkansas Medicaid mix usually need it worked as its own queue rather than mixed into commercial follow-up, because the submission path, the timely filing window and the appeal route are all different.

What a medical billing seat does in Arkansas

Aged accounts receivable called until they close, and denials read, appealed and tracked.

In Arkansas the queue that costs the most is Arkansas Medicaid, because its filing window and appeal route are not the commercial ones.

• Worklist worked from the difficult end, not the easy end
• Every call logged with the payer reference and the outcome
• Denials categorised so the same reason stops recurring
• Appeals written and submitted, not just re-bills
• Weekly written summary of what moved and what did not
• Worked during Arkansas business hours, not queued overnight

Most of the Arkansas work we see comes out of Little Rock, Fayetteville and Fort Smith, though nothing about a seat depends on where your office is — the queue is worked through your system, not from your building.

Arkansas borders 6 states, and practices near those lines almost always carry at least one out-of-state Medicaid enrollment. That is a separate portal, a separate filing window and a separate appeal route from Arkansas Medicaid, and it is the queue that most often goes unworked because it belongs to nobody.

What Arkansas law gives you

30 days for clean claims submitted electronically, 45 days for claims submitted by other means. The deadline is in the Arkansas Insurance Department rule (23 CAR § 15-110, Rule 43), not the statute — Ark. Code § 23-66-215 only sets the 12% per annum late-payment penalty and delegates the timeframe to the Commissioner.

Source.

Arkansas Medicaid, in practice

Mostly fee-for-service, with two carve-outs rather than general MCOs: the PASSE program (provider-led risk-bearing entities; the DHS fact sheet states 'There are four organizations in Arkansas that follow the PASSE model') covers only high-need behavioral-health and IDD beneficiaries, while Medicaid expansion adults are covered through ARHOME premium assistance into commercial Marketplace plans. Source

Arkansas buys private commercial coverage for its Medicaid expansion population instead of enrolling them in Medicaid managed care: 'The State proposes to continue to provide premium assistance to purchase coverage offered by Qualified Health Plans (QHPs) that participate in the individual insurance Marketplace in Arkansas.' Practically, an ARHOME patient presents a commercial QHP card and the claim is billed to that carrier under commercial rules, not to Arkansas Medicaid — so eligibility checks that stop at the Medicaid portal will mis-route the claim. Source

On the commercial side the dominant Blue plan here trades as Arkansas Blue Cross and Blue Shield, which matters mainly because its portal and its appeal route are the ones your seat will spend the most time in. Source

We have not been able to source Arkansas’s own Medicaid filing limit from the regulation itself, so this page does not quote one — the federal floor is twelve months from the date of service and a state may set a shorter window. Ask your Arkansas Medicaid representative for the figure in writing before you rely on it. The states we could source are listed here.

Working Arkansas hours

Arkansas runs on Central time, 11 hours behind our floor in Rawalpindi. To be at a desk for your nine to five, the shift here runs 8pm to 4am, and 7pm to 3am once the clocks go forward. Pakistan does not observe daylight saving, so the shift moves on this side rather than yours.

That is the part that decides whether follow-up happens at all: a payer’s phone lines are open on Arkansas hours and nobody else’s.

What it costs in Arkansas

$1,600

Per seat, per month, in US dollars — $19,200 a year for one full-time person, forty hours a week, on Arkansas hours. No annual contract, no percentage of collections, no setup fee and no software to buy. Seat prices across all roles in Arkansas run $1,400 to $2,350; the full list is published.

That is the entire invoice. Run your own figures against a percentage vendor or a hire rather than take ours.

Getting started in Arkansas

About a week from a signed agreement to a person working your queue, and that week of training on your workflow is not billed on top. The work happens in your own system under a login you issue, so there is nothing to migrate and nothing to install. The week, step by step, and what is signed before anyone has access.

Questions