Program areas at 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 or the licensure certification 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 five state agencies that avail themselves of afmc's services for their clients: division of Medical services (dms); division of county operations (dco); division of aging, adult & behavioral health services (daabhs); division of provider services & quality assurance; and division of child & family services (dcfs). Through the deliverables of this contract, we perform two primary functions: (1) serve to liaise between the state provider network and the state agencies, and (2) serve the clients of the respective state agencies. Our mission is to provide valuable customer service for all individuals who are eligible for services through Arkansas's social services systems, primarily the medicaid program. We perform outreach to educate and seek feedback from the providers of Arkansas to ensure sufficient access to health Care and Medical resources. We offer services to clients receiving benefits through the state's medicaid program as well as clients seeking mental health, substance use, opioid use disorder assistance, and children entering the foster care/adoption system. We serve our internal and external clients with customized, efficient, and effective services to ensure access to needed resources and services to promote the highest probability of success in their daily lives. We accomplish this through purposeful growth and sustainable profitability with experienced cutting-edge systems, processes, and standards as well as a staff dedicated to serving people with excellence. Our outreach, education, communication, and contact service center activities demonstrate our mission as we educate those with whom we interact, resolve their inquiries, and ensure access to necessary services. 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. A multi-disciplinary team consisting of physicians, nursing, and administrative staff apply Medical necessity review protocols and expertise for utilization review. During the sfy 2024 our clinical services department performed 104,862 prior authorization reviews and 63,336 retrospective reviews. In addition, this team provides other services such as drug monograph development, expert witness for appeal hearings, and cpt/hcpcs code reviews. Through this work, we ensure appropriate utilization of services and beneficiaries receive treatment that conforms to standards of Care and evidenced based practices. Provided review services as required by contract:prior authorization of assistant surgeon - 377prior authorization of mumps - 0prior authorization of dme - 28,003targeted case management review - 0physician drug review - 4,583 emergency room review - 45,334 inpatient review - 20,516retro review - 33,575out of state - 75emergency medicaid non-covered - 0extension of benefit/molecular pathology review - 0molecular pathology - 4,805organ transplant review - 70pvt option reviews - 0nicu -0therapy personal Care - 0private duty nursing - 318suspended claims - 898medical transport - 659epsdt - 4long term Care - 0formula - 0medical supplies - 228appeal hearings - 131oppd - 133lab and radiology - 18,685professional services - 25,759