Arkansas Foundation for Medical Care (AFMC)

Dpsqa inspection of Care (ioc)the state's dhs division of provider services & quality assurance (dpsqa) ioc contract with afmc continues to consist of three types of reviews: health and safety, quality of Care and inspection of Care (including intensive visits with division of youth services facilities). Through this work, we ensure program service providers meet their medicaid participation requirements and their clients are receiving quality services. Our ioc team is field-based and scattered across the state.

Mcaid beneficiary relations & net administration contract / call center servicesthrough this contract, we have three state agencies that avail themselves of afmc's call center services with their clients: division of county operations (dco); division of Medical services (dms); and division of aging, adult & behavioral health services (daabhs). Through the deliverables of this contract, we offer services to clients receiving benefits through the state's medicaid program and to clients seeking mental health, substance use, or opioid use disorder assistance. Our mission is to provide valuable customer service for all individuals who are eligible for services through Arkansas medicaid program. We will serve our internal and external customers with customized and accomplished service within our industry by accelerating extraordinary growth and sustainable profitability with experienced cutting-edge standards. We shaped our mission to provide accurate and precise information about member's health Care coverage. We demonstrate our mission by meticulously educating our members and resolving their inquiries while enhancing and exceeding their overall expected intentions, such as providing information about enrollment to their health plan, which specifically fits their category. This contract continues to grow while meeting all deliverables.

Arkansas medicaid review - our clinical review team, based in our fort smith office, performs utilization review for the state's medicaid program. Through diligently applying Medical necessity review protocols and expertise, this team saved the state of Arkansas approximately $17 million last year through this contract. Provided review services as required by contract:prior authorization of assistant surgeon - 552prior authorization of mumps - 7,195prior authorization of dme - 29,308targeted case management review - 0physician drug review - 4,895retro emergency room review - 47,249retro inpatient review - 34,709out of state - 101emergency medicaid non-covered - 132extension of benefit/molecular pathology review - 44,668molecular pathology - 6,197organ transplant review - 69pvt option reviews - 4nicu -0therapy personal Care - 0private duty nursing - 314suspended claims - 911ambulance - 500epsdt - 7long term Care - 0formula - 0medical supplies - 244appeal hearings - 132