Referring, ordering, prescribing or attending (ROPA) care providers will be required to register with AHCCCS for claims reimbursement and UnitedHealthcare Community Plan of Arizona has implemented this requirement into our claims processing guidelines.
The Electronic Visit Verification (EVV) hard claim edits will be in effect for date of service starting January 1, 2023. Please review the AHCCCS notice for specific information to avoid claim non-payment and denials.
COVID-19 Resources for Providers
ADHS - Antivirals - Information on antiviral prioritization criteria and where to find them.
05.09.2023 - AHCCCS, in association with U of A, is launching the Arizona Perinatal Access Line (APAL), which allows the maternity provider to connect with a perinatal psychiatrist for clinical guidance.
04.28.2023 - Translation/Interpretation Services are available for all UnitedHealthcare Community Members. The existing phone number and codes provided will be inactive as of April 30th. 2023. Effective May 1, 2023, please contact Provider Services to request translation or interpretation services for our members by calling 1-800-445-1638.
12.08.2022 - Providers need to revalidate or re-enroll with AHCCCS or risk disenrollment. If you need to re-enroll or revalidate, please use this link to the APEP Portal https://azahcccs.gov/APEP. If you have questions about the process, you can contact firstname.lastname@example.org and include the following information: APEP application ID number, name and NPI number.
12.07.2022 - Arizona Revised Statute §36-109 requires that ADHS collect the following information each quarter from hospital, health care facility and outpatient substance abuse treatment providers that provide substance use treatment. Please find the survey link for Quarter 3 (July 1, 2022 to September 30, 2022) of Calendar Year 2022 below. ADHS is requesting that your facility complete the survey no later than December 15, 2022. Here is the Survey Monkey link: https://www.surveymonkey.com/r/KYW29NW..The information you submit is important to assessing Arizona's progress in meeting the treatment needs of people throughout the state. The information is analyzed and compiled into a quarterly report that is provided to the Governor, the Presidents of the Arizona House and Senate, and the Arizona Secretary of State's Office. The quarterly reports are also posted on the ADHS opioid website at https://azhealth.gov/opioid under the reporting tab. If you have any questions or comments, please email email@example.com , and an ADHS staff will reach out to you.
11.17.2022 - Synagis Prior Authorization (PA) protocols - New Requirements /Change to Process. Effective Friday November 11th, AHCCCS notified the MCOs that the state PDL-imposed Synagis Prior Authorization (PA) protocols should now be waived by the AHCCCS contractors for eligible plan members under the age of 2 years. For UHC Community Plan (UHCCP) members, the PA process also serves as an opportunity to ensure the therapy is being ordered from the correct specialty pharmacy, Optum Specialty Rx, and can be efficiently delivered to the correct treatment sites. Although UHCCP has taken steps to remove the PA requirements per AHCCCS for eligible members less than 2 years of age, providers must continue to utilize the approved network pharmacy Optum Rx. To order, providers must call Optum Specialty at 855-427-4682 to provide the necessary information to support provider requests for UHCCP eligible membership. Synagis coverage information can be found here: Synagis® (Palivizumab) – Community Plan Medical Benefit Drug Policy Synagis® (Palivizumab) – Community Plan Medical Benefit Drug Policy (uhcprovider.com)
11.16.2022 - AHCCCS has recently updated all the Durable Medical Equipment (DME) Category of Service ( AHCCCS COS) 15 and Medical Supply (AHCCCS COS) 40 codes to match the Center for Medicare Services list on DMEPOS. All code ranges have been re-entered into the system as single codes due to the specific AHCCCS COS for the specific code. Also updated was the DME Place of Service for all DME codes to match current National Coding Standards. Current guidance states for DME, the place of service billed must be under the POS that the member will use the DME product even if it is dispensed from the provider's office. AHCCCS temporarily updated reference tables for the following: Place of Service 11 is added back to V2020-V2799 with no lapse until 9/1/2022. Providers should update their billing systems as claims after that date will not be allowed. AHCCCS Medical Coding Resources, News and Updates: https://www.azahcccs.gov/PlansProviders/MedicalCodingResources.html
11.10.2022 - Are you interested in providing school-based services? Arizona Health Care Cost Containment System (AHCCCS) covers school-based health care services, like medically necessary behavioral health services, for Medicaid-enrolled students. UnitedHealthcare Community Plan of Arizona connects health care providers with schools and school districts for these and other programs. If you’re interested in providing school-based services, please talk to Pilar Vargas, Children’s Healthcare Administrator, at firstname.lastname@example.org or 602-255-8880.
10.27.2022 - “EPSDT AMPM 430 was updated 10/1/22” – Changes included Attachment A (EPSDT Periodicity Schedule) and Attachment E (EPSDT Clinical Sample Templates) revised to include “Postpartum Depression Screening” for birthing parent and “Suicide Screening” for members ages 10-20 y.o., language added to clarify there is no limit to glasses replacements. A section was added to allow for counseling visits for immunizations exclusive to a well child visit. Language was revised to align with most recent changes in AMPM 431. Language added to cover cochlear implants for unilateral severe hearing loss. A section was added to address transition out of EPSDT for members. A section was added for developmental surveillance and language clarified for developmental screening.” AHCCCS Medical Policy Manual (AMPM) (azahcccs.gov)
10.17.2022 - DUGless Portal Guide - All health care professionals who typically provide social determinant/demographic/outcome elements with no identified alternative data source or Social Determinant diagnosis identifier can access the DUGless Portal.
09.11.2022 - AHCCCS is pleased to be partnering with BCBS Arizona Health Choice's Office of Individual and Family Affairs (OIFA) for a presentation about Adult Family Support in the Homeless Sector on Friday, October 7 at 10:00am. To register email Denise Cox at email@example.com. For general questions about the training email Jaime Green at firstname.lastname@example.org.
09.02.2022 - AHCCCS has purchased training seats for Mental Health Block Grant and Substance Abuse Block Grant providers with the American Academy of Child and Adolescent Psychiatry (AACAP) to receive training on the Early Childhood Service Intensity Instrument (ECSII) at no cost. To purchase click to create an account and use the 100% discount code ARNAECS. For questions reach out email@example.com.
08.30.2022 - AHCCCS has updated the Prepaid Medical Management Information System (PMMIS) and the Telehealth Code Set excel link on our website to include POS 02 Telehealth Provided Other than in Patient’s Home and POS 10 Telehealth Provided in Patient’s Home for applicable codes effective 1/1/22. For questions regarding telehealth coding standards, please contact the AHCCCS medical coding team at CodingPolicyQuestions@azahcccs.gov.
03.16.2022 - EPSDT Services - Eyeglass Replacements and Repair - As part of EPSDT, eyeglasses and other vision services, including replacement and repair of eyeglasses, for members under the age of 21 years are covered by AHCCCS to correct or ameliorate conditions discovered during vision screenings for EPSDT.
01.25.2022 - Mandatory Treatment Capacity Survey - Arizona Revised Statute §36-109 requires that each quarter, each hospital, health care facility and outpatient substance abuse treatment provider that provides substance abuse treatment submit to the Department the following information. For the 2021 quarter four (Q4), ending December 31, 2021, please use the above Survey Monkey link and complete the survey no later than January 28, 2022.
11.30.2021 - Opioid Treatment Program (OTP) Requirements - Per new Arizona Revised Statute, AHCCCS is required to make reports submitted by registered AHCCCS Outpatient Treatment Programs (OTP) publicly available to allow for the 30-day public comment period. Those reports have been posted and are available.
10.01.2021 - Update: Abuse and Neglect Prevention Task Force Seeks Survey Input from Long Term Care Providers - As part of the work of the Governor’s Abuse and Neglect Prevention Task Force, AHCCCS and the Arizona Department of Economic Security, are asking long term care health care providers who serve AHCCCS members to participate in a short survey conducted by the Sonoran Center for Excellence for Developmental Disabilities (UCEDD). The survey is anonymous and has been extended to October 15, 2021.
Access the articles shared in the monthly network news brief emails. Arizona-specific information is identified along with the date the article was shared. Review this regularly to keep up to date on the Community Plan of Arizona updates and reminders.
Medical Policy Update Bulletins
For Medical Policies, Medical Benefit Drug Policies, Coverage Determination Guidelines, Utilization Review Guidelines and corresponding update bulletins for UnitedHealthcare Community Plan, visit the Policies and Protocols section.