Billing Manual for IHS/Tribal Providers

IMPORTANT: The links below lead to individual files in PDF format. Or you can click here to download the entire manual at once in a self-extracting ZIP compressed archive (2.9 MB).  Some of the hyperlinks in these PDF files lead to other PDF files in the manual. You must save all of the manual's files to the same location for these internal links to work.

TABLE OF CONTENTS (52KB)

Chapter 1: Introduction to AHCCCS (130KB)

• Exhibit 1-1, AHCCCS Acute Care Health Plans (56KB)
• Exhibit 1-2, AHCCCS Long Term Care Program Contractors (60KB)
• Exhibit 1-3, Indian Health Services (IHS) Offices (41KB)
• Exhibit 1-4, Help Line Directory (43KB)

Chapter 2: Eligibility (57KB)

Chapter 3: Provider Records and Registration (99KB)

Chapter 4: General Billing Rules (135KB)

Chapter 5: Claim Form Requirements (1.5MB)

Chapter 6: Authorization/Referrals (39KB)

Chapter 7: Medicare/Other Insurance Liability (163KB)

Chapter 8: Individual Practitioner Services (126KB)

• Exhibit 8-1, Hysterectomy Consent Form (10KB)

Chapter 9: Hospital and Clinic Services (103KB)

Chapter 10: Pharmacy Services (80KB)

• Exhibit 10-1, RxAmerica Prior Authorization Request (43KB)

Chapter 11: Transportation Services (69KB)

• Exhibit 11-1, Transportation Prior Authorization Request Form (85KB)

Chapter 12: Behavioral Health Services (90KB)

Chapter 13: Home Health Care Services (40KB)

Chapter 14: ALTCS Services (125KB)

• Exhibit 14-1, Sample ALTCS Authorization Letter (79KB)
• Exhibit 14-2, ALTCS Offices (37KB)

Chapter 15: Nursing Facility Services (72KB)

Chapter 16: Claims Processing (53KB)

Chapter 17: Correcting Claim Errors (153KB)

• Exhibit 17-1, Claim Correction Request Form (87KB)
• Exhibit 17-2, Claim Status Request Form (48KB)

Chapter 18: Understanding the Remittance Advice (340KB)

• Exhibit 18-1, Sample Remittance Advice - Address Page (182KB)
• Exhibit 18-2, Sample Remittance Advice - Financial Summary (80KB)
• Exhibit 18-3, Sample Remittance Advice - Paid Non-Facility Claims (81KB)
• Exhibit 18-4, Sample Remittance Advice - Denied Non-Facility Claims (80KB)
• Exhibit 18-5, Sample Remittance Advice - Adjusted Non-Facility Claims (81KB)
• Exhibit 18-6, Sample Remittance Advice - Voided Non-Facility Claims (80KB)
• Exhibit 18-7, Sample Remittance Advice - Non-Facility Claims in Process (80KB)
• Exhibit 18-8, Sample Remittance Advice - Processing Notes (80KB)
• Exhibit 18-9, Sample Remittance Advice - Paid Facility Inpatient Claims (81KB)
• Exhibit 18-10, Sample Remittance Advice - Paid Facility Outpatient Claims (172KB)
• Exhibit 18-11, Sample Remittance Advice - Denied Facility Claims (80KB)
• Exhibit 18-12, Sample Remittance Advice - Adjusted Facility Claims (80KB)
• Exhibit 18-13, Sample Remittance Advice - Voided Facility Claims (80KB)
• Exhibit 18-14, Sample Remittance Advice - Facility Claims in Process (80KB)

Chapter 19: Claim Disputes (71KB)

Back to Top