A. Patient presents for abortion examination at the provider.

B. Physician makes determination that the pregnancy is the result of rape or incest.

C. Physician completes the certification form (DMS-2698) certifying that the pregnancy resulted from forcibly compelled sexual intercourse or incest as defined under Ark. Code Ann. § 5-14-103 and § 5-22-202.

D. Physician contacts the Department of Human Services (DHS), Division of Medical Services (DMS), Administrator, Utilization Review, for prior authorization of the abortion procedure as required in the Arkansas Medicaid Physician’s Manual. View or print the Utilization Review contact information.

E. DHS, DMS notifies the physician within 24 hours of prior approval or if necessary, requests more complete information for the required physician’s review.

F. Provider receives approval and performs the procedure.

G. Provider submits the claim and required documentation, including patient history and physical examination records, for payment to the Department of Human Services, Division of Medical Services, Utilization Review unit. View or print the Utilization Review contact information. If the documentation is complete with the claim, the DMS Utilization Review nurse will approve for processing. Processing includes determination of Medicaid eligibility and third party availability.

H. DHS, DMS notifies the third party source of prior authorization for the beneficiary.

I. An Explanation of Benefits (EOB) Message will be returned to the provider on their remittance advice, stating that the abortion procedure is covered by a standing third party source, with instruction to seek reimbursement accordingly.

J. Third party source provides payment to the provider. Payment is in accordance with 42 USCA 433.139.