Clinical & Payment Policies

To easily search for a policy, use the Ctrl+F (Command+F on Mac) function on your keyboard to search by keyword, policy number, or effective date.

All policies found in the Arkansas Total Care Clinical Policy Manual apply to Arkansas Total Care members. Policies in the Arkansas Total Care Clinical Policy Manual may have an “Arkansas Total Care” or a “Centene” heading. Arkansas Total Care uses InterQual^® criteria for services for which an Arkansas Total Care clinical policy does not exist. InterQual is a nationally recognized, evidence-based decision support tool. You may access the InterQual SmartSheets™ for adult and pediatric procedures, durable medical equipment (DME), and imaging procedures by logging in to our Secure Provider Portal or calling Arkansas Total Care at 1-866-282-6280 (TTY: 711).

Arkansas Total Care may use a vendor for the utilization management of certain services. In such cases, the vendor’s guidelines may also be used to support medical necessity and other coverage decisions. Other non-clinical policies, such as payment policies, or contract terms may also be used to determine if a service that is not addressed in the Clinical Policy Manual or InterQual criteria is payable by Arkansas Total Care.

Arkansas Total Care has partnered with Evolent for prior authorization requests for the following services:

• Spinal Epidural Injections

• Paravertebral Facet Joint Injections or Blocks

• Paravertebral Facet Joint Denervation (Radiofrequency Neurolysis)

• Sacroiliac Joint Injections

Clinical Policies for these procedures can be found at the RadMD website.

Clinical Policies for CT/CTA/CCTA, MRI, MRA, and Pet scans can also be found at the Evolent Website RadMD website.

Clinical policies for musculoskeletal procedures can be found on the Turning point website at TurningPoint Healthcare.

Clinical policies for Continuous Glucose Monitors may be found on the Arkansas Medicaid Prime Therapeutics website.

 Prior Authorization statistics may be viewed at the Prior Authorizations Electronic Prior Authorization Submissions.