Q: How do I know if a service is covered by AHCCCS?
A: The AHCCCS Medical Policy Manual describes covered services
Q: Do I need to obtain a prior authorization?
A: AHCCCS does not prior authorize services provided in an IHS or 638 facility.
Q: If an AHCCCS American Indian Health Program member is seen by a registered nurse at my facility, can I bill for the nurse's service?
A: No. You can only bill for services provided by an AHCCCS-registered provider. AHCCCS does not register RNs.
Q: What acute care providers can register with AHCCCS?
A: AHCCCS registers the following IHS providers:
Q: Where do I send my claim for covered services? What if services are provided to an AHCCCS-contracted health plan member?
A: If the member is Title XIX (Medicaid) eligible, the claim should be submitted to AHCCCS, regardless of whether the member is enrolled in the AHCCCS American Indian Health Program (formerly IHS/AHCCCS) or if the member is enrolled in a health plan.
If the member is Title XXI (KidsCare) eligible, the claim should be submitted to AHCCCS if the member is enrolled in the AHCCCS American Indian Health Program. If the member is enrolled in an AHCCCS-contracted health plan, the claim should be submitted to that plan.
Q: How do I submit claims online?
A: You may submit claims online by using our AHCCCSOnline companion website.
Q: How many OMB rates can be billed per member per day?
A: AHCCCS will reimburse IHS/638 providers for up to three OMB rates based on the number and types of services provided to a member on the same day.
Q: How can I verify an American Indian AHCCCS member's enrollment?
A:
Phone Verifications:
Q: Is an AHCCCS American Indian Health Program (formerly IHS/AHCCCS) member allowed to change to a health plan and vice versa at any time?
A: Yes. The member can change enrollment from an AHCCCS-contracted health plan to the AHCCCS American Indian Health Program, or vice versa, at any time by calling the AHCCCS Administration. If the AHCCCS member chooses to change health plans, the same requirements as for other health plan members would apply.
Q: Am I able to provide covered services to an AHCCCS American Indian Health Program (formerly IHS/AHCCCS) member?
A: Yes. However, be aware that certain services require prior authorization from AHCCCS.
A: Yes; for certain services. Prior authorization from AHCCCS is required for the following services:
Q: How do I obtain prior authorization?
You may phone or fax the AHCCCS Prior Authorization Unit to request authorization.
To obtain a prior authorization by telephone, providers must call Monday through Friday between 9am to 11:30am, and 12:30pm to 4pm.
The AHCCCS Prior Authorization Unit's fax number is 602-256-6591.
Allow at least three working days for your request to be processed.
Q: Where do I send my claim? What if services are provided to an AHCCCS-contracted health plan member?
A: If the member is enrolled in the AHCCCS American Indian Health Program (formerly IHS/AHCCCS), the claim should be submitted to AHCCCS. AHCCCS will reimburse you the fee-for-service rate for the service(s) provided. If the member is enrolled in an AHCCCS-contracted health plan, the claim should be submitted to that plan.
Q: What do I need to do to set up non-emergency transportation for an IHS/AHCCCS member?
A: Non-emergency ground round-trip transports of 100 miles or less do not require prior authorization from AHCCCS. Round-trip transports of more than 100 miles do require authorization from either the AHCCCS Prior Authorization Unit (acute care members) or a case manager (ALTCS members). Only codes for base and mileage will be authorized.
Prior authorization requests for fee-for-service acute care American Indian Health Program members must be faxed to the AHCCCS Prior Authorization Department at (602) 417-4687. Make sure that the Prior Authorization Request Form is complete and always verify the individual's AHCCCS eligibility.
To request authorization via telephone, please call 602-417-4400. Select Option 1.
For questions or more information about prior authorization of non emergency transportation, please contact Jamaal Matthews, AHCCCS Fee-for Service Transportation Coordinator, at 602-417-7546 or via email at Jamaal.Mathews@azahcccs.gov.
Q: Where do I send pertinent medical records for an American Indian Health Program member upon discharge?
A: That depends. If the member was not referred from a facility, you may ask the patient who their primary provider or facility is and obtain the release of medical records to that provider.
Q: Our provider's office is not contracted with AHCCCS, but would like to provide services to an AHCCCS American Indian Health Program member. What do we need to do to register?
A: Visit AHCCCS Provider Registration.
