Medical Billing Services in Arkansas
Billing, coding, credentialing and denial management for Arkansas practices, with Medicare claims through Novitas Solutions (Jurisdiction JH) and Arkansas Medicaid handled by people who know the rules.
Medical billing for Arkansas practices
Arkansas has an unusual Medicaid setup. Traditional Arkansas Medicaid pays most physician claims fee-for-service, expansion adults under ARHOME are covered through private marketplace plans, and members with complex behavioral health or developmental disability needs are enrolled in PASSE organizations. Medicare Part B is processed by Novitas Solutions in Jurisdiction H, and Arkansas Blue Cross and Blue Shield holds a large share of commercial business.
For a practice in Little Rock, Fayetteville or the Delta, that means one Medicaid patient may be billed three different ways. SFA Solutions works with practices across Arkansas remotely. We work inside your existing EHR, identify the correct payer at intake, submit most clean claims within 24 hours and keep follow-up moving on open balances.
Arkansas at a glance
| Medicare contractor | Novitas Solutions, Jurisdiction JH |
|---|---|
| Medicaid timely filing | 12 months from the date of service for fee-for-service claims; PASSE and ARHOME carriers set their own limits |
| NP practice authority | Reduced |
| Cities we serve | Little Rock, Fayetteville, Fort Smith, Springdale, Jonesboro, Rogers, Conway, Bentonville, Pine Bluff, Hot Springs |
What Arkansas billing involves
These are the programs and rules our team works with for Arkansas claims.
Medicare
Novitas Solutions · JHArkansas Part B claims are processed by Novitas Solutions in Jurisdiction JH. Medicare's filing limit is 12 months from the date of service, and appeals start with a redetermination within 120 days of the initial decision.
Arkansas Medicaid
Arkansas Medicaid; ARHOME for expansion adults; ARKids First for children
Portal: Arkansas Medicaid provider portal (the state's MMIS) for enrollment and fee-for-service claims
Medicaid managed care
Most physician claims are paid fee-for-service. ARHOME adults are covered through private qualified health plans, so their claims go to that insurer. Members with complex behavioral health or developmental disability needs are enrolled in a PASSE: Arkansas Total Care, CareSource PASSE, Empower Healthcare Solutions or Summit Community Care.
Timely filing
12 months from the date of service for fee-for-service claims; PASSE and ARHOME carriers set their own limits.
Commercial and Medicare Advantage
Arkansas Blue Cross and Blue Shield is the largest commercial carrier, with UnitedHealthcare, QualChoice, Ambetter and Cigna also common. Humana and UnitedHealthcare lead Medicare Advantage.
Prompt pay law
Arkansas Insurance Department Rule 43 requires health carriers to pay or deny a clean claim within 30 days of receipt when it is submitted electronically and within 45 days when it is submitted by other means. Clean claims still unpaid after 60 days carry a penalty of 12% per year.
Nurse practitioners
Reduced practiceArkansas nurse practitioners generally practice under a collaborative practice agreement with a physician. After 6,240 hours under a collaborative agreement, an NP can apply for full independent practice authority through the state's Full Independent Practice Credentialing Committee.
Credentialing
Providers enroll with Arkansas Medicaid through the Department of Human Services provider enrollment process, and PASSE organizations and ARHOME carriers credential separately. Arkansas Blue Cross and Blue Shield and most national carriers use CAQH ProView, so the profile needs current attestation. Medicare enrollment goes through PECOS with Novitas JH.
Billing challenges Arkansas practices face
Three Medicaid billing paths
An Arkansas Medicaid patient might be fee-for-service, an ARHOME member billed to a private carrier or a PASSE member. Billing the wrong one results in a denial and lost time against the filing deadline. We check eligibility for the correct payer before the claim leaves.
Strict 12-month Medicaid limit
Arkansas Medicaid claims must be filed within 12 months, and retroactive eligibility does not extend that limit. Claims that stall in rejection status can age out quickly. Weekly review of unpaid Medicaid claims keeps them inside the window.
Rural payer mix
Practices in the Delta and Ozark regions see a high share of Medicare, Medicaid and dual eligible patients. Crossover claims between Novitas and Arkansas Medicaid need careful tracking so the secondary balance gets paid. Small balances left unworked add up.
Our services in Arkansas
Medical Billing
Learn moreCredentialing & Payer Enrollment
Learn moreMedical Coding
Learn moreDenial Management
Learn moreA/R Recovery
Learn moreEligibility Verification & Prior Authorization
Learn moreMedical Billing Audit
Learn moreRevenue Cycle Management
Learn moreSpecialties we bill in Arkansas
Arkansas medical billing questions
What is the timely filing limit for Arkansas Medicaid?
Arkansas Medicaid requires fee-for-service claims to be filed within 12 months of the date of service. Retroactive eligibility does not extend that deadline. PASSE plans and ARHOME carriers set their own limits in provider agreements.
What is ARHOME?
ARHOME is Arkansas's Medicaid expansion program for adults. Most members are covered through private qualified health plans, so you bill the carrier listed on the member's card, not traditional Arkansas Medicaid.
What is a PASSE in Arkansas?
A PASSE (Provider-led Arkansas Shared Savings Entity) is a managed care organization for Medicaid members with complex behavioral health needs or intellectual and developmental disabilities. The current PASSEs include Arkansas Total Care, CareSource PASSE, Empower Healthcare Solutions and Summit Community Care.
Who is the Medicare contractor for Arkansas?
Novitas Solutions processes Medicare Part B claims for Arkansas under Jurisdiction H, which also covers Texas, Oklahoma, Louisiana and several other states. Enrollment updates go through PECOS.
Get a free billing audit for your Arkansas practice
We will review your recent claims and denials against Arkansas payer rules and show you what can be recovered.
Nearby states
Primary sources
- CMS: Who are the MACs, A/B MAC Jurisdiction H (JH)
- Arkansas Medicaid Provider Manual, Section III (016.06.05 Ark. Code R. 036)
- Arkansas DHS PASSE fact sheet
- Arkansas Insurance Department Rule 43, Unfair Claims Settlement Practices (054.00.15 Ark. Code R. 005)
- Arkansas Full Independent Practice Credentialing Committee
Payer rules change. Last reviewed against the primary sources above on . Confirm current rules with the payer before relying on them.
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