Provider
For our health plan, this customer care group handles all provider related questions.
What is Provider Experience Center? PEC
A time frame when an AHCCCS member can renew or change their health plan.
What is open enrollment?
October 1st though September 30th
What is AHCCCS benefit period?
Our traditional acute Medicaid health plan for individuals who qualify on an income level.
What is Banner University Family Care?
Health plan for members who are 65 years and old OR member who qualify based on a mental or physical disability OR member's who require nursing facility care.
What is Arizona Long Term Care System? ALTCS
Letter sent to providers when they bill our member by mistake.
What is a Cease letter?
SR created to update a member's primary insurance.
What is a coordination of benefits? COB
A way for our members to get to and from their medically necessary appointments.
What is transportation? (Veyo)
Incentive for EPSDT member's during summer.
What is Well Child Visit?
Social worker types who will determine the member's needs and how they can assist.
What are case managers?
A way for us to identify the provider.
What is a Tax ID or NPI?
Request made by a member to change plans.
What is an AHCCCS Health Plan Change request?
Member's 21 and over are not covered for these basic benefits.
What are basic vision and dental?
Out of State Coverage
What is emergency coverage only?
Time it takes for a Case Manager to contact a new ALTCS member.
What is 7 business days?
Company used for Advanced Imaging, Nuclear Medicine, Cardiac Imaging, Medical Oncology, Radiation Therapy, MSK-Therapies (PT/OT), MSK-Pain/Joint/Surgery prior authorization.
What is EviCore?
Request made for their doctor to speak with our doctor in regards to a denial request.
What is Peer to Peer?
Referrals never needed for services.
What is OBGYN and Behavioral Health?
Covered for up to $1000 for certain circumstances.
What is Emergency Dental?
Internal team we can reach out to for assistance on POA or guardianship.
What is ALTCS Aides?
DOUBLE JEOPARDY: If a provider falls under one of these, they must be registered to receive payment.
What is ROPA? Referring, Ordering, Prescribing, Attending (1000pts)
Second Level Appeal
What is a State Fair Hearing?
DOUBLE JEOPARDY: A comprehensive child health program of prevention and treatment, correction, and improvement of physical and behavioral health conditions for AHCCCS members under the age of 21.
What is Early and Periodic Screening, Diagnostic and Treatment? (EPSDT) (1000pts)
Can be requested if the member needs additional medical care or help understanding their medical diagnosis.
What are Care Managers?
Along with $1000 emergency coverage, member's also have $1000 covered for diagnostic, therapeutic and preventive care.
What is dental services?