Provider Resources

QuickReference Links for Authorization Requirements and Guidelines

All Clinical policies (criteria) should be reviewed prior to initiating any procedure that does not require prior authorization.

Authorization requirement and Payment Policy Guidelines

• Clinical/Payment Policies
• Prior Authorization Tool
• Machine Readable Prior Authorization List (updated quarterly)
• InterQual guidelines

Authorization Submission Locations

• Turning Point
• Evolent
• Availity Portal / ARTC Provider Portal

For the latest announcements, refer to the provider news page.

Reference Materials

• 2025 Provider Manual (PDF)
• 2024 Provider Manual (PDF)
• 2023 Provider Manual (PDF)
• 2022 Provider Manual (PDF)
• 2021 Provider Manual (PDF)
• 2019 Provider Manual (PDF)
• Quick Reference Guide (PDF)
• Payspan (PDF)
• Secure Portal (PDF)
• Provider Education Member ID Card (PDF)
• How to Check Eligibility (PDF)
  
• ICF Billing Instructions (PDF)
  
• Incident Report (PDF)
• How to Use Secure Messaging (PDF)
• Codes Modifiers and Rates (PDF)
• Provider Waiver Manual (PDF)
• Provider Waiver Manual (PDF) RETIRED
• Lab Compensation Schedule (PDF)
• DME Compensation Schedule (PDF)
• Negative Balance How To Guide (PDF)
• ICF Member Responsibility Claims Processing Update (PDF)
• New Individual & Family Therapy Billing Guidance (PDF)
• First-Line Psychosocial Care for Children and Adolescents on Antipsychotics (APP) (PDF)
• Long-Acting Medications as First-Line Treatment in Schizophrenia (PDF)
• Supportive Living Criteria (PDF)
• Supportive Living Provider Level 2 & Level 5 Rate Request Form (PDF)
  
• Supportive Living Physician/Clinician Recommendation for Level 2 & Level 5 Rates Form (PDF)
  
• Residential Prior Authorization Form for Initial Request (PDF)
• Therapeutic Community Authorization Form Level 1 (PDF)
• Therapeutic Community Authorization Form Level 2 (PDF)
• Remittance Advice/Explanationof Payment (EOP) Guide (PDF)
• Psychotropic Medication Usage in Children and Adolescents (PDF)
• Arkansas Roster Template

Partnerships in Care

In our Partnerships in Care program, we collaborate with selected providers that serve our high-need members to maximize provider strengths and offer clinical support to improve patient outcomes.  If you are identified as a provider that could benefit from participation in the Partnerships in Care program through a data analysis, we will notify you via email and provide a detailed introduction about the program. We will then use data analytics and clinical reviews to collaborate with you to highlight areas of strength and opportunities to help improve the lives of our members. 

• ABA Transition Planning Tip Sheet (PDF)
• ABA Behavior Assessments and Plans Tip Sheet (PDF)
• ABA Caregiver Training Tip Sheet (PDF)
• ABA Med Management Tip Sheet (PDF)
• ABA Prescription fulfilment Training Tip Sheet (PDF)

Provider Newsletter

• Provider Newsletter - Spring 2022 (PDF)
• Provider Newsletter — Fall 2021 (PDF)
• Provider Newsletter — Spring 2021 (PDF)
• Provider Newsletter — Q2 2019 (PDF)
• Provider Newsletter — Q1 2019 (PDF)

Medical Management

• Pre-Auth Needed?
• Prior Authorization 2019 Guidelines (PDF)
• How To Secure Prior Authorization (PDF)
• How To Submit Prior Authorization (PDF)
• Inpatient Prior Authorization Fax Form (PDF)
• Outpatient Prior Authorization Fax Form (PDF)
• Supplemental Outpatient Prior Authorization Form (PDF)
• Behavioral Health PA Guidelines (PDF)
• Waiver Treatment Plan Template Fillable Form (PDF)
• CES Waiver Emergency Request Form (PDF)
• Waiver Services Authorization Form (PDF)
• POA Inpatient Requirements (PDF)
• Permission for Property Modification Letter (PDF)
• Personal Care Services Request Form and Service Plan (PDF)
• Benefit Inquiry Form (PDF)
• Personal Care Information Sheet (PDF)

Claims and Claim Payment

• Claims Payment Tool (PDF)
  
• Electronic Transactions (PDF)
• Claim Dispute Form (PDF)

Provider Credentialing

Attention: If you would like to become a provider within our network, please fill out the Become A Provider form. Or call us at 1-866-282-6280 or TTY: 711.

• Allied- and Advance-Practice Nurse Credentialing Application (PDF)
• Medical Doctor or Doctor of Osteopathy Credentialing Application (PDF)
• Atypical and Non-licensed Practitioners Roster Template
• Arkansas State Medical Board Attestation Form 2020 (PDF)
  This form must be returned with your MD/DO Credentialing Application (PDF) in order to complete your submission.
• Arkansas Total Care Atypical & HCBS Provider Application (PDF)
• Provider Data Change Form (PDF)

HEDIS Tips and Quick Guides

• Reducing the Stigma: Mental Illness (PDF)
• Assess, Educate, and Treat Patients with Depression (PDF)
• Medications for Opioid Use Disorder (MOUD) — Buprenorphine (PDF)
• Opioid Overdose Prevention (PDF)
• Safer Prescribing for Pain Management and Opioids (PDF)
• Substance-Related Use Disorder (PDF)
• Early and Periodic Screening, Diagnosis, and Treatment Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) (PDF)
• Antipsychotic and Antidepressant Medication Adherence (PDF)
• CAHPS ECHO Survey document (PDF)
• Patient Care when Prescribing Antipsychotic Meds (PDF)
• Reducing the Risk of Opioid Overuse and Misuse (PDF)
• SUD Treatment and Engagement (PDF)
• Telehealth for Behavioral Health Care (PDF)
• The Importance of Depression Screenings (PDF)
• The Importance of First-Line Psychosocial Care (PDF)
• The Importance of Metabolic Monitoring (PDF)
• The Importance of Follow-Up Care for Mental Illness (PDF)
• Depression Screening Tip Sheet (PDF)  Spanish (PDF) | Marshallese (PDF)
• Controlling Blood Pressure (CBP) (PDF)
• The Importance of Regular Follow-Up for ADHD (PDF)
• HEDIS® Tips: Acute Bronchitis (PDF)
• Blood Pressure Control for Patients With Diabetes (BPD)
• Appropriate Testing for Pharyngitis (CWP) (PDF)
• Appropriate Treatment for Upper Respiratory Infection (URI) (PDF)
• The Importance of Depression Screenings (PDF)

Tips and Forms

• PAI Provider Self Reporting Form (PDF)
• Patient Engagement in Behavioral Care Flyer (PDF)
• Pharmacotherapy for Opioid Use Disorder (POD) (PDF)