Third Party Accounts and Pharmacy Benefit

The Third Party Accounts unit serves as the liaison for the School Based Claiming program, Pharmacy Benefit Manager (PBM), and various County Department of Corrections (DOC) accounts.

The School Based Claiming program offers reimbursement for both the provision of covered medically necessary school-based services (Direct Service Claiming) and the costs of administrative activities (Medicaid Administrative Claiming), such as outreach, which supports the Medicaid school-based program. AHCCCS contracts with Public Consulting Group (PCG) Education to administer the program statewide. This program serves about 30,000 Arizona Medicaid eligible students.

AHCCCS utilizes a PBM to manage the FFS pharmacy benefit. The PBM adjudicates the pharmacy claims for certain FFS populations and provides customer services for members, pharmacy providers, and prescribers.

Various Counties contract with AHCCCS to process their AHCCCS eligible inpatient claims. This unit currently includes two claims adjudication and customer support staff who work with each of the DOC stakeholders and providers.