Provider Resources

Arkansas Total Care provides the tools and support you need to deliver the best quality of care.

Reference Materials

• Provider Newsletter - Winter 2018 (PDF)
• Provider Newsletter - Q1 2019 (PDF) - Coming soon
• 2019 Provider Manual (PDF) - Coming soon
• Quick Reference Guide (PDF)
• Payspan (PDF) - Coming soon
• Secure Portal (PDF) - Coming soon
• Provider Education Member ID Card (PDF) - Coming soon
• Prior Authorization Guide (PDF) - Coming soon

Medical Management

• Pre-Auth Needed?
• Prior Authorization Guide (PDF) - Coming soon
• Inpatient Prior Authorization Fax Form (PDF) - Coming soon
• Outpatient Prior Authorization Fax Form (PDF) - Coming soon
• Grievance, Appeal, Concern or Recommendation Form (PDF)

Behavioral Health

• Discharge Consultation Form (PDF) - Coming soon
• Electroconvulsive Therapy (ECT) Authorization Request Form (PDF) - Coming soon
• Intensive Outpatient/Day Treatment Form for Mental Health/Chemical Dependency (PDF) - Coming soon
• Outpatient Treatment Request Form (PDF) - Coming soon
• OTR Tip Sheet (PDF) - Coming soon
• Psychological or Neuropsych Testing Authorization Request Form (PDF) - Coming soon

Claims and Claim Payment

• Electronic Transactions (PDF) - Coming soon
• Claim Dispute Form (PDF) - Coming soon
• Health Care Claim: Professional (837) (PDF)
• Health Care Claim: Institutional (837) (PDF)

Provider Credentialing

Attention: If you would like to become a provider within our network, please fill out the Become A Provider form. Or call us at 1-866-282-6280 or TDD/TTY: 711.

• Credentialing Atypical Provider Application (PDF) - Coming soon
• Allied and Advance Practice Nurse Credentialing Application (PDF)
• Medical Doctor or Doctor of Osteopathy Credentialing Application (PDF)