Providers

Provider Manual

Provider Manual
Chapter 1Introduction to Health Choice Arizona
Chapter 2Member Eligibility and Member Services
Chapter 3Provider Responsibility
Chapter 4Cultural Competency
Chapter 5Quality Management
Chapter 6Medical Authorizations and Notifications
Chapter 7General Billing Rules
Chapter 8Billing on the CMS 1500 Claim Form
Chapter 9Billing on the UB Claim Form
Chapter 10Billing on the ADA Claim Form
Chapter 11Claims Processing
Chapter 12Correcting Claim Errors
Chapter 13Understanding the Remittance Advice
Chapter 14Medicare and Other Insurance Liability
Chapter 15Claim Disputes, Member Appeals, and Member Grievances
Chapter 16Women and Children’s Services
Chapter 17Pharmacy and Drug Formulary
Chapter 18Behavioral Health Services
Chapter 19Hospital Services
Chapter 20Oral Health Services
Chapter 21
Financial Reporting Guide
Chapter 22Care Management
Exhibits
 Exhibit 1.1Provider Escalation Notice
Exhibit 3.2EPSDT and Dental Periodicity Schedule
Exhibit 3.5.1Missed Medical Appointment Log
Exhibit 3.5.2 Missed Dental Appointment Log
 Exhibit 3.7EPSDT Tracking Form Order Sheet
Exhibit 3.38.1
BHH Corporate Compliance Evaluation Form
Exhibit 3.38.2
Corporate Compliance Training Certification Form
Exhibit 3.38.3
Performance of Exclusion Checks Attestation Form
Exhibit 4.1Interpreter Services
 Exhibit 5.1Case Management Referral Form
Exhibit 6.2 Medical Services Prior Authorization Form
Exhibit 6.9A CRS Qualifying Medical Conditions
Exhibit 13.1 Medical Remittance Advice
Exhibit 13.2Dental Remittance Advice
Exhibit 13.3Remittance Denial Codes
Exhibit 16.1 CRS Application – English
Exhibit 16.2CRS Application – Spanish
Exhibit 16.3 Federal Sterilization Consent Form
Exhibit 16.4 Newborn Reporting Form
 Exhibit 16.5Hysterectomy Consent Form
Exhibit 16.8Certificate of Medical Necessity for Commercial Oral Nutritional Supplements
Exhibit 16.10Maternal Risk Assessment
Exhibit 17.1Formulary Addition Request Form
Exhibit 17.2 Pharmacy Services Prior Authorization Form
Exhibit 17.3Psychotropic Medication Monitoring Program
Exhibit 17.4ePrescribing Information
Exhibit 17.5
HIE eRX Information
Exhibit 20.1 Dental Specialty Request form
Exhibit 20.2 Dental Matrix – Under 21
Exhibit 20.3Dental Matrix – Over 21
 Exhibit 430-4AzEIP AHCCCS Member Service Request Form
 Exhibit 431-1A AHCCCS Dental Periodicity Schedule