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Medicaid Utilization Management Program (MUMP)

The Arkansas Department of Human Services instituted the Medicaid Utilization Management Program (MUMP) to determine reimbursement for lengths of stay for all inpatient acute care/general and rehabilitative hospital services. Services performed in lone standing psychiatric facilities are excluded.

AFMC performs the review under contract to Arkansas Medicaid.

A registered nurse Clinical Services Specialist initially screens the MUMP request. If the documentation submitted supports medical necessity, a Clinical Services Specialist may approve the request.

If the Clinical Services Specialist is unable to approve medical necessity of the requested service, the review is referred to a physician advisor for determination. AFMC utilizes physicians who are licensed in the state of Arkansas to review the prior authorization requests. The physician advisor uses his/her medical judgment in accordance with established Medicaid policies to review medical necessity of the requested service.

Providers are encouraged to utilize the preferred method of submitting electronic requests through the web-based Arkansas Medicaid Healthcare Provider Portal. If you are not currently enrolled to submit electronic requests, please visit the link below or reach out to your provider representative for assistance.

Benefits of utilizing the Arkansas Medicaid Healthcare Provider Portal for electronic submissions: 

  1. Reduces time and expense associated with paper submissions
  2. 24/7 access for providers to submit requests and review results
  3. Requests can be tracked from submission to completion.
  4. Providers can view decision results immediately upon review completion.
  5. FREE
  6. Secure and HIPAA compliant
  7. Records can be directly attached to the request.

Arkansas Medicaid Provider Portal

AFMC/MMIS Outreach Specialist Information Sheet

AFMC pre-certification: Call 800-426-2234
AFMC Clinical Services phone review hours: 8:00 a.m.-12:00 p.m. and 1:00 p.m.-4:30 p.m. Monday through Friday, except for holidays. All calls are monitored for quality assurance purposes.

Groups affected

All age groups and Medicaid eligibility categories, except for recipients under age 1, are affected by this policy. The policy includes all acute care/general and rehabilitative hospitals, in or out-of-state. Please see item 5, Transmittal No. 52, for the procedure to follow when a child’s first birthday occurs during an inpatient stay.

Instructions for applying the MUMP procedures are detailed in Section 212.520 in the Arkansas Medicaid Hospital Provider Manual.

Electronic submission via Arkansas Medicaid Healthcare Provider Portal:

Submission of documentation to include the following:

  1. Patient name and address (including zip code)
  2. Patient birth date
  3. Patient Medicaid number
  4. Admission date
  5. Hospital name
  6. Hospital Medicaid provider number
  7. Attending physician Medicaid provider number
  8. Principal diagnosis and other diagnoses influencing this stay
  9. Surgical procedures performed or planned
  10. The number of days being requested for continued inpatient care
  11. All available medical information justifying or supporting the necessity of continued stay in the hospital

Telephone procedure

The procedure for the MUMP telephone review with AFMC is as follows:

  1. Patient name and address (including zip code)
  2. Patient birth date
  3. Patient Medicaid number
  4. Admission date
  5. Hospital name
  6. Hospital Medicaid provider number
  7. Attending physician Medicaid provider number
  8. Principal diagnosis and other diagnoses influencing this stay
  9. Surgical procedures performed or planned
  10. The number of days being requested for continued inpatient care
  11. All available medical information justifying or supporting the necessity of continued stay in the hospital

Notice of adverse actions, reconsideration, appeals and hearings

If AFMC is unable to fully approve any requested service, all applicable parties are notified in writing of the review determination along with detailed instructions on how to request an appeal.

Reconsideration requests

The provider may request reconsideration of the denial within 35 calendar days of the date on the denial letter. Requests must be made in writing and include a copy of the denial letter and additional documentation to substantiate the medical necessity of the requested services. Requests received after 35 calendar days of the denial date will not be accepted for reconsideration.

If the denial decision is reversed during the reconsideration review, an approval is forwarded to the provider specifying the approved units and services. If the denial decision is upheld, the provider and the Medicaid client will be notified in writing of the review determination. Reconsideration is available only once per prior authorization request.

Reconsiderations can be submitted utilizing the same methods as the initial request; however, the preferred method is electronically through the Arkansas Medicaid Healthcare Provider Portal.

Fair hearing requests

The Medicaid client may request a fair hearing of a denied review determination made by either the Utilization Review Department of Human Services (DHS) or AFMC. The fair hearing request must be in writing and sent to the Appeals and Hearings Section of DHS within 35 calendar days of the date on the denial letter.

Providers may refer to section 190.000 of the Arkansas Medicaid Provider Manual for more information. Medicaid Provider Fair Hearing requests must be sent to Arkansas Department of Health, Medicaid Provider Appeals Office, 4815 West Markham Street – Slot 31, Little Rock, AR 72205.

Contact us

If you have further questions on specific reviews, please email us at This email address is being protected from spambots. You need JavaScript enabled to view it. or contact AFMC’s Clinical Services Department at 479-649-8501, option 1.

Appeals

Learn more about the Medicaid Fairness Act.

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Physician Reviewers

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