Provider Resources

Arkansas Total Care provides the tools and support you need to deliver the best quality of care.

Reference Materials

• 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)
• Remittance Advice/Explanationof Payment (EOP) Guide (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)

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)

Tips and Forms

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