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AHCCCS Health Plans

Details: Available Health Plans. If you are waiting for your application to be processed or you are not eligible for AHCCCS medical assistance, you may qualify to receive drug and alcohol and mental health treatment services through other funding sources administered by the Regional Behavioral Health

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› Url: http://www.azahcccs.gov/choice Go Now

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Health Information Exchange (HIE)

Details: Health Current, Arizona’s health information exchange, connects more than 500 Arizona organizations, including first responders, hospitals, labs, and providers of community behavioral health, physical health, post-acute care, and hospice providers. Download and print the AHCCCS HIE flyer.

› Verified 6 days ago

› Url: https://www.azahcccs.gov/AHCCCS/Initiatives/HIT/HIE.html Go Now

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Health Equity Committee

Details: Health Equity Committee. Formally established in July 2020, the Health Equity Committee is tasked with understanding health disparities and developing strategies to ensure health equity for all AHCCCS members. The committee is responsible for overseeing and managing health equity considerations as they relate to policy, data, health plan

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› Url: https://www.azahcccs.gov/AHCCCS/Initiatives/HEC/ Go Now

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Arizona System of Care

Details: Since July 1, 2016 when the Arizona Department of Health Services, Division of Behavioral Health was incorporated into AHCCCS through Administration Simplification, AHCCCS has been expanding efforts to further the System of Care model to include the adult population, and to incorporate an integrated health perspective. System Oversight Structure

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› Url: https://www.azahcccs.gov/Resources/OversightOfHealthPlans/SystemOfCare.html Go Now

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Health Net Access

Details: Health Net Access. August 7, 2015 – AHCCCS has received notification of an acquisition by Centene Corporation of Health Net Inc., the ultimate parent company of Health Net Access. Notification of Change in Ownership; AHCCCS Approval of Acquisition Request (01/11/2016) HNA Transition Response (10/30/2015) Attachments (10/30/2015)

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› Url: https://www.azahcccs.gov/Resources/OversightOfHealthPlans/HealthNetAccess.html Go Now

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Provider Claim Disputes

Details: Provider Claim Disputes. AHCCCS providers of health care services may file a Claim Dispute to challenge payments or denials of claims. The request for a …

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› Url: https://www.azahcccs.gov/PlansProviders/RatesandBilling/FFS/providerclaimdisputes.html Go Now

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NYS DSRIP: An Overview

Details: •Transformation of the health care safety net at both the system and state level •Reducing avoidable hospital use and improve other health and public health measures at both the system and State level •Ensure that delivery system transformation continues beyond the waiver period through leveraging managed care payment reform

› Verified 9 days ago

› Url: https://www.azahcccs.gov/AHCCCS/Downloads/Initiatives/DSRIP/DSRIP%20Stakeholder%20Meeting-Greg%20Allen%20Presentation-12-8-15.pdf Go Now

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State Medicaid Advisory Committee (SMAC)

Details: V. Introduction of New Division of Health Care Advocacy and Advancement Paul Galdys Assistant Director VI. Introduction of New Member Organization Dr. Frank Scarpati CEO/President, Community Bridges, Inc. VII. Autism Spectrum Disorder Report and Pharmacy and Therapeutics Committee Update Dr. Sara Salek Chief Medical Officer VIII.

› Verified 5 days ago

› Url: https://www.azahcccs.gov/AHCCCS/Downloads/SMAC/agendas/SMACAgenda423161.pdf Go Now

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WHERE CAN I FIND THE COVID-19 VACCINE

Details: Each county prioritizes their vaccine distribution according to their populations. It can be different from county to county. However, as of 3/24/2021, adults over the age of 16 now qualify for the COVID-19 vaccine at the state-run sites in Maricopa, Pima, and Yuma counties.

› Verified 6 days ago

› Url: https://www.azahcccs.gov/AHCCCS/AboutUs/findvaccine.html Go Now

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Proposed State Rules

Details: The Health Care Group program will no longer have an appropriation as described under A.R.S. 36-2912.01 and will cease to exist January 1, 2014. New enrollment into Health Care Group ceased August 1, 2013.

› Verified 8 days ago

› Url: https://azahcccs.gov/Resources/OversightOfHealthPlans/State/proposedrules.html Go Now

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GENERAL INFORMATION

Details: Arizona Health Care Cost Containment System IHS/Tribal Provider Billing Manual account activation cannot be done by the provider's clearinghouse, software vendor, or billing service. How can a provider request ERA setup? The AHCCCS Information Services …

› Verified 7 days ago

› Url: https://www.azahcccs.gov/PlansProviders/Downloads/IHS-TribalManual/IHS-Chap18Remits.pdf Go Now

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Social Determinants of Health

Details: What Are Social Determinants of Health. Social Determinants of Health are the conditions in which a person is born into, grows, lives, works and agesthat impact their health. Social Determinants of Health take into account factors such as the member’s education, employment, physical environment, socioeconomic status, and social support network.

› Verified 9 days ago

› Url: https://azahcccs.gov/Resources/Downloads/DFMSTraining/2021/SocialDeterminantsofHealth.pdf Go Now

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THE AHCCCS BENEFIT PACKAGE

Details: physician services, rural health services, federally qualified health center services, labora-ray tory and x services, family planning services, nurse midwife services, certified pediatric and family nurse practitioner services, freestanding birth center services, transportation to medical care and tobacco

› Verified 8 days ago

› Url: https://azahcccs.gov/AHCCCS/Downloads/AHCCCS%20Benefit%20Package.pdf Go Now

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Private Sector Partners

Details: Connecting Communities: The Importance of Private Sector Partners. The AHCCCS mandatory managed care program was founded upon a competitive, public/private partnership model where all members (except American Indians/Alaska Natives enrolled in AIHP) are enrolled in private health plans for physical, behavioral, and long term care services.

› Verified 6 days ago

› Url: https://www.azahcccs.gov/AHCCCS/Initiatives/PrivateSectorPartners/ Go Now

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ARIZONA HEALTHCARE COST CONTAINMENT SYSTEM …

Details: statutory transfer of behavioral health responsibilities from the Arizona Department of Health Services to the Arizona Health Care Cost Containment System (AHCCCS). Therefore, the Chapter name has been amended from Department of Health Services to the Arizona Health Care Cost Containment System at 22 A.A.R. 2019, effective July 12,2016.

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› Url: https://www.azahcccs.gov/Shared/Downloads/Reporting/AHCCCSdirectory.pdf Go Now

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Centene Corporation (DE)

Details: Health Net Health Plan of Oregon, Inc. (OR) 23-2867299 HSI Advantage Health Holdings, Inc. (DE) 23-2867300 QualMed Plans for Health of Western Pennsylvania, Inc. (PA) 25-1516632 Pennsylvania Health Care Plan, Inc. (PA) 06-1116976 Health Net of the Northeast, LLC (DE) 6 68-0390435 FH Surgery Centers Inc. (CA) 3 68-0214809 Health Net Federal

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› Url: https://www.azahcccs.gov/Resources/Downloads/HealthNetAccess/CorporateStructureOrgChart.pdf Go Now

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Social Determinants of Health

Details: What Are Social Determinants of Health. 2 • Social Determinants of Health are the conditions in which a person is born into,grows, lives, worksand ages that impact their health. • Social Determinants of Health takeintoaccount factors such as the member’s education, employment, physical environment,socioeconomic status,and social support

› Verified 2 days ago

› Url: https://www.azahcccs.gov/Resources/Downloads/DFMSTraining/2021/SocialDeterminantsofHealth_10012021.pdf Go Now

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American Rescue Plan Allocations

Details: American Rescue Plan Allocations. AHCCCS is working to implement the recently passed federal law, American Rescue Plan Act of 2021 (ARPA).ARPA is an emergency legislative package to fund vaccinations, provide immediate, direct relief to families impacted by the COVID-19 public health emergency, and support struggling communities.

› Verified 9 days ago

› Url: https://www.azahcccs.gov/AHCCCS/Initiatives/ARPA/index.html Go Now

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Important Notice

Details: Health Services (IHS), tribal health programs operated under 638, or any other AHCCCS registered provider. AI/AN members who enroll with AIHP for their physical health services also receive their behavioral health services through AIHP, or may choose to receive their behavioral health services through a TRBHA, if a TRBHA is available in their area.

› Verified 3 days ago

› Url: https://www.azahcccs.gov/PlansProviders/Downloads/FFSIHStribalbillingManualDrafts/Chapter_19_Behavioral_Health_Services.pdf Go Now

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AHCCCS IHS/Tribal Provider Billing Manual

Details: AHCCCS IHS/Tribal Provider Billing Manual. The AHCCCS Billing Manual for Indian Health Service (IHS)/Tribal Providers contains information ranging from introductory information about AHCCCS to claim disputes.. Download Entire Manual . The IHS/Tribal Provider Billing Manual is intended to outline billing requirements for providers who are billing the AHCCCS IHS/Tribal unit for reimbursement.

› Verified 9 days ago

› Url: https://www.azahcccs.gov/PlansProviders/RatesAndBilling/ProviderManuals/IHStribalbillingmanual.html Go Now

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AHCCCS – Demographics, Social Determinants and Outcomes

Details: AHCCCS began (April 1, 2018) to require Providers use of Social Determinants of Health diagnosis codes on applicable claims to track member outcomes. The Specific ICD-10 diagnosis codes representing Social Determinants of Health are a valuable source of information as to factors that impact or potentially impact member health.

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› Url: https://azahcccs.gov/PlansProviders/Demographics/ Go Now

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AHCCCS Related Acronyms

Details: Mental Health of America, a non-profit organization that advocates for those diagnosed with a mental illness. MI/MN Medically Indigent/Medically Needy MIKID Mentally Ill Kids in Distress is a service provider that provides support and assistance to families in Arizona with behaviorally challenged children, youth and young adults. MMA

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› Url: https://azahcccs.gov/shared/Acronyms.html Go Now

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Telehealth Services and Billing Guidelines

Details: health care provider delivers health care through telemedicine, the treating health care provider shall obtain verbal or written informed consent from the patient or the patient's health care decision maker. If the informed consent is obtained verbally, the health care provider shall document the consent on the patient's medical record.

› Verified 3 days ago

› Url: https://www.azahcccs.gov/Resources/Downloads/DFMSTraining/2020/FALL2020_TelehealthServicesForIHS_638Providers.pdf Go Now

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AHCCCS POPULATION BY HEALTH CARE CONTRACTOR

Details: Nov-20 Dec-20: Jan-21 Feb-21: Mar-21 Apr-21: May-21 Jun-21: Jun-21 Aug-21: Sep-21 Oct-21: One Year Change % of Growth: United Healthcare Community Plan 394,173

› Verified 9 days ago

› Url: https://www.azahcccs.gov/Resources/Downloads/PopulationStatistics/2021/Oct/PopulationByContractor_2021_10.pdf Go Now

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Accessing Behavioral Health Services in Schools

Details: Behavioral health services for children who qualify for Medicaid (AHCCCS) may receive services through their AHCCCS health plan. Further, uninsured and underinsured students may also receive behavioral health services paid by AHCCCS under the Mental Health Block Grant (MHBG), the Substance Abuse Prevention and Treatment Block Grant (SABG), and, for a limited time, with the Children’s

› Verified 5 days ago

› Url: https://azahcccs.gov/AHCCCS/Initiatives/BehavioralHealthServices/ Go Now

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PA Criteria for Behavioral Health Inpatient Admission

Details: A behavioral health diagnosis is required for admission to an inpatient setting; also, a behavioral health diagnosis is required to be documented at the time of discharge from inpatient services. BEHAVIOR AND FUNCTIONING Imminent risk of danger to self or others as a result of a behavioral health

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› Url: https://www.azahcccs.gov/PlansProviders/FeeForServiceHealthPlans/PriorAuthorization/criteria.html Go Now

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Revenue Codes Service Description Provider Types FFS Rate

Details: Arizona Health Care Cost Containment System FFS Behavioral Health Inpatient Rates Effective 10/01/2020 Version 10/01/2020 Revenue Codes

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› Url: https://azahcccs.gov/PlansProviders/Downloads/FFSrates/Behavioral/FY21FinalWebsiteRatesBehavioralHealthInpatient.pdf Go Now

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Chapter 2 Eligibility

Details: The health plan is responsible for prior period coverage from 05/01 (start of eligibility) through 06/18 (day before the enrollment is being processed). The plan is capitated at the appropriate PPC rate for this period. Starting 06/19, the plan is capitated under the appropriate on-going rate.

› Verified 9 days ago

› Url: https://azahcccs.gov/PlansProviders/Downloads/FFSProviderManual/FFS_Chap02Eligibility.pdf Go Now

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FEE-FOR-SERVICE PROVIDER BILLING MANUAL

Details: • For physical health use ICD-10 code R68.89, or • For behavioral health use ICD-10 F99. SPECIALTY CARE TRANSPORTS Specialty care transports are services for high-risk members through the Maternal Transport Program (MTP) and the Newborn Intensive Care Program (NICP) administered by the Arizona Department of Health Services (ADHS).

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› Url: https://azahcccs.gov/PlansProviders/Downloads/FFSProviderManual/FFS_Chap14Transportation.pdf Go Now

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Application for AHCCCS Health Insurance and Medicare

Details: • The health plan works with health care providers (doctors, hospitals, pharmacies, etc.) to provide all AHCCCS covered services. • The health plan will send you a member handbook once you are enrolled. • You can call the health plan if you have any questions about your benefits or services or if you

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› Url: https://www.azahcccs.gov/Members/Downloads/DE103.pdf Go Now

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Court Ordered Evaluation (COE)/ Court Ordered Treatment

Details: You cannot submit a behavioral health claim and a physical health claim for the same stay. The county shall be billed (or the county’s TPA) for the COE, and bill the ACC Plan (or RBHA for a member with an SMI designation) or AIHP for the COT. Assuming the primary diagnosis on the COE stay is behavioral health, you c annot bill AHCCCS for

› Verified 7 days ago

› Url: https://www.azahcccs.gov/AHCCCS/Downloads/ACC/COE-COT.pdf Go Now

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Behavioral Health Residential Facility AHCCCS Medical

Details: Behavioral Health Residential Facilities that are designated as an Indian Health Services (IHS) facility, or a Tribal 638 facility being operated by a Tribe or Tribal organization, do not require prior authorization. No Prior Authorization is required for IHS/638 facilities, for members enrolled under Title XIX.

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› Url: https://www.azahcccs.gov/Resources/Downloads/DFMSTraining/2020/FALL2020_BHRFPolicy320V.pdf Go Now

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IHS/TRIBAL PROVIDER BILLING MANUAL HAPTER LAIM ISPUTES

Details: Arizona Health Care Cost Containment System IHS/Tribal Provider Billing Manual If action on a timely submitted, clean claim fewer than 60 days before the expiration of the 12-month deadline or after the 12-month deadline has passed, the provider will be allowed 60 days from the date of the adverse action to file a claim dispute with OALS.

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› Url: https://www.azahcccs.gov/PlansProviders/Downloads/IHS-TribalManual/IHS-Chap19Grievances.pdf Go Now

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AHCCCS STRATEGIC PLAN

Details: The Arizona Health Care Cost Containment System (AHCCCS), the State’s Medicaid Agency, uses federal, state, and county funds to provide health care coverage to the State’s acute and long-term care Medicaid populations. Since 1982, when it became the first statewide Medicaid

› Verified 7 days ago

› Url: https://azahcccs.gov/AHCCCS/Downloads/Plans/StrategicPlan_17-22.pdf Go Now

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AMPM Policy 320-O

Details: a. Behavioral health providers shall supply completed ssessment or a service and reatment t plan documentation to the health home for inclusion in the member’s medical record. 7. The Behavioral Health Assessments, Serviceand Treatment Plan shall be included in the , medical record as specified in AMPM Policy 940. 8.

› Verified 5 days ago

› Url: https://www.azahcccs.gov/shared/Downloads/MedicalPolicyManual/300/320-O.pdf Go Now

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Customer Service Numbers How to Contact Us

Details: health system, you have access to several options to help you address your concerns. Deciding which op-tion to use depends on the nature of the issue, what result you want, and how much time you can spend on the issue. This brochure provides basic information about what options are available and how to use them. Ways to Raise your Concerns

› Verified 2 days ago

› Url: https://azahcccs.gov/Members/Downloads/RandRBrochures/ComplaintGrievanceAppeal.pdf Go Now

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School & Behavioral Health Partnerships

Details: Mental health can be impacted by the home and social environment, early childhood adversity or trauma, physical health, and genetics. 3. FIGURE 1 . Currently, most western health care systems do not utilize a wellness model. A wellness model frames mental health care as a preventative activity with health impact similar to regular brushing and

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› Url: https://azahcccs.gov/AHCCCS/Downloads/Initiatives/BehavioralHealthServices/100104-ADOE-SBRG.pdf Go Now

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FAQs for Non-Emergency Transportation

Details: Bill the appropriate health plan. IHS/638, if billing for Acute NEMT service : Bill AHCCCS. Non-IHS billing for an ALTCS NEMT service : Bill the appropriate health plan. IHS/638, if billing for ALTCS NEMT service : Bill AHCCCS. Behavioral Health for NEMT service : Bill the appropriate TRBHA/RBHA. Tribal ALTCS for NEMT service : Bill AHCCCS.

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› Url: https://www.azahcccs.gov/PlansProviders/RatesAndBilling/ProviderManuals/NEMT.html Go Now

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Quality Strategy July 2021

Details: 2.3 Health Equity 10 2.4 Transition of Care 10 2.5 AHCCCS Initiatives and Best Practices 11 2.6 Integrated Health Care 11 2.7 Long Term Care Supports and Services 13 2.8 Centers of Excellence 16 2.9 Residential Facilities and Oversight 17 2.10 Prevention Efforts and Attention to the Overuseof Opioids 17 2.11 Foster Care Youth 18 2.12 Justice

› Verified 3 days ago

› Url: https://azahcccs.gov/PlansProviders/Downloads/QualityStrategyJuly2021.pdf Go Now

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Division of Behavioral Health Services Bureau of Quality

Details: health disorders, adults who have been determined to have a serious mental illness (SMI), and children. In addition, a contract was awarded to one RBHA in GSA6 for the provision of integrated physical and behavioral health services to Medicaid-eligible SMI adults. The goal of

› Verified 6 days ago

› Url: https://azahcccs.gov/Resources/Downloads/BehavioralHealthReports/annual-quality-management-plan-resubmitted-2014.pdf Go Now

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AMPM Policy 610, AHCCCS Provider Qualifications

Details: Medicaid, and the Children’s Health Insurance Program (CHIP) as specified in 42 CFR 457 and 42 CFR 438, Centers for Medicare and Medicaid Services (CMS) mandates that AHCCCS require all providers to be screened in accordance with Federal and State law, regulations, and rules including the following: 1.

› Verified 9 days ago

› Url: https://azahcccs.gov/shared/Downloads/MedicalPolicyManual/600/610.pdf Go Now

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