016.29.22 Ark. Code R. § 012 - Primary Care Case Management (PCCM) Reconciliation

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.

Notes

016.29.22 Ark. Code R. § 012
Adopted by Arkansas Register Volume 48, Number 1, Effective 12/26/2022

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