Health Choice Arizona -- Providers

Provider Manual

Chapter 1	Introduction to Health Choice Arizona - Updated Nov 2009 Exhibit 1-1 Health Choice Arizona Network Contact List - Updated Nov 2009
Chapter 2	Member Eligibility and Member Services - Updated Nov 2009
Chapter 3	Provider Responsibility - Updated April 2010 Exhibit 3-1.1 Immunization Schedule, 0-6 year olds - New Jan 2008 Exhibit 3-1.2 Immunization Schedule, 7-18 year olds - New Jan 2008 Exhibit 3-1.3 Immunization Schedule, Adults - New Jan 2008 Exhibit 3-2 EPSDT Periodicity Schedule - Updated Jan 2009 Exhibit 3-3 Certification of Medical Necessity, Oral Nutritional Supplement - Updated Jan 2008 Exhibit 3-4 Sample EPSDT Form - Updated Jan 2008 Exhibit 3-5.1 Medical Missed Appointment Form - New - Jan 2009 Exhibit 3-5.2 Dental Missed Appointment Form - Updated - Jan 2009 Exhibit 3-6 Marketing Approval Form Exhibit 3-7 Health Choice Arizona EPSDT Tracking Form Order Sheet - Updated Oct 2009
Chapter 4	Cultural Compentency - Updated Nov 2009
Chapter 5	Quality Management - Updated Nov 2009 Exhibit 5-1 Health Choice Case Management Referral Form - Updated Nov 2009
Chapter 6	Authorizations and Referrals - Updated April 2010 Exhibit 6-1 Prior Authorization Requirements - Updated Aug 2010 Exhibit 6-2 Medical Services Prior Authorization (PA) Form - Updated Aug 2010 Exhibit 6-3 Dental Specialty Referral Request Form - Updated Dec 2009 Exhibit 6-4 Sample Dental Specialty Referral Determination Form - Updated Dec 2008 Exhibit 6-5 Sample Prior Authorization Determination Form - Updated Dec 2008 Exhibit 6-6 Dental Clinical Guidelines are now posted in the Provider Portal. Exhibit 6-7 Dental Matrix - Updated April 2010 Exhibit 6-8A Nationwide Vision Referral Form - all ages - Updated Nov 2009 Exhibit 6-8B Nationwide Vision Centers for DM Eye Exams - Updated Nov 2009 Exhibit 6-9A CRS Manual, Chapter 5 - New Nov 2009 Exhibit 6-9B CRS Diagosis List - New Nov 2009
Chapter 7	General Billing Rules - Updated Nov 2009
Chapter 8	Billing on the CMS 1500 Claim Form - Updated Nov 2009
Chapter 9	Billing on the UB Form - Updated Nov 2009
Chapter 10	Billing on the ADA 2006 Claim Form - Updated Dec 2009
Chapter 11	Claims Processing - Updated Nov 2009
Chapter 12	Correcting Claim Errors - Updated Nov 2009 Exhibit 12-1 Claim Status Inquiry Form Exhibit 12-2 Denial Codes - Updated Jan 2008
Chapter 13	Understanding the Remittance Advice - Updated Nov 2009 Exhibit 13-1 Sample Medical Remittance - Updated Jan 2009 Exhibit 13-2 Sample Dental Remittance - Updated Jan 2009
Chapter 14	Medicare/Other Insurance Liability - Updated Feb 2010
Chapter 15	Claim Disputes and Member Appeals- Updated Nov 2009
Chapter 16	Women and Children's Services - Updated Dec 2009 Exhibit 16-1 CRS Application Form (English) - Updated December 2008 Exhibit 16-1 CRS Application Form (Spanish) - updated December 2008 Exhibit 16-2 Sterilization Consent Form Exhibit 16-3 Maternal Child Health, Request for Total OB Authorization- Updated June 2010 Exhibit 16-4 Newborn Reporting Sheet Exhibit 16-5 Request for Hysterectomy Exhibit 16-6 RSV Prevention, Synagis Eligibility Assessment - updated October 2009 Exhibit 16-7 CRS Policy and Procedure Manual - New December 2008 Exhibit 16-8 Certification of Medical Necessity, Oral Nutritional Supplement
Chapter 17	Pharmacy and Drug Formulary - Updated April 2008 Exhibit 17-1 Request for Addition to the Formulary - Updated Jan 2009 Exhibit 17-2 Specialty Drug List - New, April 2008 Exhibit 17-3 Pharmacy Services Prior Authorization (PA) Form- Updated Aug 2010 Exhibit 17-4 Synagis Eligibility Assessment- New Nov 2009
Chapter 18	Behavioral Health Services - Updated Nov 2009 Exhibit 18-1 This Exhibit is intentionally left blank Exhibit 18-2 Regional Behavioral Health Authorities - Updated Nov 2009 Exhibit 18-3 Behavioral Health Services Referral Form Exhibit 18-4 RBHA Acute Care Health Plan and Provider Coordinator Contact List - New Nov 2009
Chapter 19	Hospital Services - Updated Nov 2009
Chapter 20	Oral Health Services - Updated Nov 2009
Chapter 21	HC Generations Provider Manual Section 1 - Introduction Section 2 - Member Services Section 3 - Provider Responsibility - Updated Nov 2008 Section 4 - Cultural Competency Section 5 - Quality Management Section 6 - Medical Authorizations & Referrals Section 7 - Inpatient & Oupatient Hospital Care Section 8 - Coordination of Benefits or Other Insurance Liability Section 9 - Grievance, Appeals, Claim Resubmission and Reconsiderations - Updated Nov 2008 Section 10 - Drug Formulary Section 11 - Transplant Services Section 12 - Covered Benefits

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Copyright © 2006. Health Choice Arizona, 410 N. 44th Street, Ste. 900 Phoenix, AZ 85008 Last Update 10/29/2008. Health plan services are funded in part through a contract with AHCCCS and the State of Arizona. Copyright © 2006. Health Choice Arizona, 410 N. 44th Street, Ste. 900 Phoenix, AZ 85008 Last Update 10/29/2008. Health plan services are funded in part through a contract with AHCCCS and the State of Arizona.