Arkansas Foundation For Medical Care Inc

Mcaid review-clinical servicesour 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 sfy 2025 our clinical services department performed 102,825 prior authorization reviews and 59,902 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 service as requried by contract prior authorization of assistant surgeon- 308prior authorization of mumps - 0prior authorization of dme - 23,507targeted case management review - 0physician drug review - 4,626 emergency room review - 45,350 inpatient review - 19,134retro review - 33,526out of state - 94emergency medicaid non-covered - 0extension of benefit/molecular pathology review - 0molecular pathology - 6,619organ transplant review - 45pvt option reviews - 0nicu -0therapy personal care - 0private duty nursing - 314suspended claims - 1,156medical transport - 1,106epsdt - 0long term care - 0formula - 0medical supplies - 237appeal hearings - 167oppd - 181lab and radiology - 22,813professional services - 23,269

Mcaid beneficiary relations & net administration contract / call center servicesthrough this contract, we have four 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. 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, and opioid use disorder assistance. 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.