Prior Quarter Coverage


Overview

Beginning January 1, 2014, the time period AHCCCS pays for covered services for an eligible individual will be extended to include the three months prior to the month the individual applied for AHCCCS, if the individual met AHCCCS eligibility requirements during the month in which the Medicaid covered service was provided. If the individual is determined to qualify for AHCCCS during any one or more of the three months prior to the month of application, then the individual will be determined to have “Prior Quarter Coverage” eligibility during those months. As a result, AHCCCS will pay for AHCCCS covered services provided during those months. Although the AHCCCS Program has previously been waived from including Prior Quarter Coverage as part of its Medicaid Program, AHCCCS is now required to include Prior Quarter Coverage starting January 1, 2014.

Providers are encouraged to utilize the Health-e-Arizona Plus (HEAplus) application process to assist in enrolling uninsured patients into AHCCCS coverage. HEAplus offers the most accurate, credible, real-time eligibility determinations for public assistance programs such as AHCCCS to help providers better manage their patients’ payment source. HEAplus will shorten the eligibility determination timeframe and simplify the process for members and providers. Anyone can access www.healthearizonaplus.gov from any internet connection. Today, hundreds of locations throughout the State use HEAplus to help Arizonans. More information about HEAplus, including how to become a Contracted Community Partner can be found on the link below:

HEAplus


Information for Providers

092413 Prior Quarter Memo

092413 Prior Quarter FAQ's

AHCCCS Prior Quarter Rule

Differences between Prior Quarter Coverage and Prior Period Coverage


Federal Interface

SPA 13-006 – Prior Quarter Coverage
Updates the State Plan to reflect that prior quarter coverage will be covered, effective January 1, 2014.

State Plan Amendments