Arkansas emergency department billing services
Professional ER billing for emergency medicine groups in Arkansas: MDM-based 99281-99285 levels, critical care time, modifier 25, payer enrollment and No Surprises Act claims, built on the Arkansas payer rules verified below.
What changes an ER claim in Arkansas.
Every Arkansas rule on file, each linked to its primary source: state surprise-billing law, Medicaid ER policy, Medicaid managed care, the Blue plan and the Medicare contractor.
| Rule type | Date | What it says | Source |
|---|---|---|---|
| State surprise-billing law | Dec 2021 | Arkansas has no state law setting out-of-network ER payment: the federal No Surprises Act IDR process sets OON ER rates for Arkansas state-regulated plans, with the Arkansas Insurance Department enforcing some NSA provisions. | Source |
| Medicaid ER policy | Jan 2023 | Arkansas Medicaid Workers with Disabilities and ARHOME (QHP) adults: $9.40 copay for non-emergency use of the ED, $0.00 for emergency room services, $4.70 for physician visits. | Source |
| Medicaid managed care | Jul 2025 | Arkansas Total Care (PASSE) applies payment policy CC.PP.053 (last reviewed 07/2025) to physicians: a 99284 or 99285 billed with a diagnosis the plan classes as lower complexity is paid at the Level 3 (99283) rate; the provider may appeal. | Source |
| Medicare contractor | Aug 2026 | Medicare Part B professional ER claims go to Novitas Solutions, A/B MAC Jurisdiction H (JH). | Source |
How we bill Arkansas ER visits.
The same four-step workflow we run for emergency medicine and hospitalist groups billing from their hospital system.
Hospital feed and registration
Demographics, insurance and the attending physician arrive from the hospital system daily. Gaps go back to registration as clarification requests, not guesses.
MDM levels and critical care minutes
ED visits 99281-99285 are coded on medical decision making only. Critical care is 99291 for 30 to 74 minutes and 99292 from 104 total minutes, on documented time.
Modifier 25 and enrollment check
A separately identifiable E/M on the day of a procedure carries modifier 25 with its own documentation. The rendering physician is checked against the payer roster before release.
Submission, remit and NSA/IDR
Professional claims go out with place of service 23. Out-of-network ER claims follow the No Surprises Act: in-network cost share only, open negotiation, then federal IDR.
FAQ: ER billing in Arkansas.
Does Arkansas have a state surprise billing law for ER care?
Arkansas has no state law setting out-of-network ER payment: the federal No Surprises Act IDR process sets OON ER rates for Arkansas state-regulated plans, with the Arkansas Insurance Department enforcing some NSA provisions.
What does Arkansas Medicaid require for ED visits?
Arkansas Medicaid Workers with Disabilities and ARHOME (QHP) adults: $9.40 copay for non-emergency use of the ED, $0.00 for emergency room services, $4.70 for physician visits.
How do Arkansas Medicaid managed care plans handle ER claims?
Arkansas Total Care (PASSE) applies payment policy CC.PP.053 (last reviewed 07/2025) to physicians: a 99284 or 99285 billed with a diagnosis the plan classes as lower complexity is paid at the Level 3 (99283) rate; the provider may appeal.
Which Medicare contractor processes Arkansas ER professional claims?
Medicare Part B professional ER claims go to Novitas Solutions, A/B MAC Jurisdiction H (JH).
How are emergency department visit levels chosen in Arkansas?
By medical decision making only. CMS states that for emergency department visits practitioners use MDM, not time, to select 99281-99285, so the note must carry the problems addressed, the data reviewed and the risk of management.
Nearby ER billing state guides.
Neighbouring state pages with their own verified ER payer rules.