Q: "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 billing source?"
A: If the 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 as in this instance 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.
Providers may always call their HP/EDS representative if they have specific Medicaid billing inquiries concerning the electronic or paper billing processes. For more information, call 1.800.457.4454.
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Helpful Tips for DMS-640
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· Must be completed in order to be valid.
· Must be signed and dated by the physician.
· Must include minutes and duration.
· Must have child's Medicaid number.
· Must cover ALL requested dates of service.
· Must mark appropriate treatment box.
For complete instruction, refer to Section II Arkansas Medicaid Provider Manual & DMS-640 electronic form page 2.
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Helpful Tips for Progress Notes
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 Provider please:
· Time in and out of each therapy session must be documented.
· Therapist must sign each date of entry with a full signature and credentials.
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Helpful Tips for Evaluations
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· Make sure to sign evaluation and include credentials.
· Make sure date covers requested dates of service.
· Clinical observations/impressions need to be
included, even if the child meets objective criteria
for therapy.
· Goals must be individualized, not verbatim from test objective.
· Speech evaluations must contain language testing even if only has articulation problem.
· Speech evaluations must include oral motor assessment and hearing must be addressed.
For complete instruction, refer to Section II Arkansas Medicaid Provider Manual.
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