Fee-For-Service Provider Manual

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TABLE OF CONTENTS (107KB)

Chapter 1: Introduction to AHCCCS (36KB)

• Exhibit 1-1, AHCCCS Acute Care Health Plans (11KB)
• Exhibit 1-2, AHCCCS Long Term Care Program Contractors (114KB)
• Exhibit 1-3, Indian Health Services (IHS) Offices (9KB)
• Exhibit 1-4, Help Line Directory (20KB)

Chapter 2: Recipient Eligibility and Enrollment (43KB)

Chapter 3: Provider Records and Registration (177KB)

Chapter 4: General Billing Rules (195KB)

Chapter 5: Billing on the CMS 1500 Claim Form (316KB)

Chapter 6: Billing on the UB-04 Claim Form (71KB)

Chapter 7: Billing on the ADA 2002 Claim Form (214KB)

Chapter 8: Authorization/IHS Referral (135KB)

• Exhibit 8-1, Sample PA Confirmation Letter (66KB)

Chapter 9: Medicare/Other Insurance Liability (171KB)

Chapter 10: Professional and Technical Services (132KB)

• Exhibit 10-1, Hysterectomy Consent Form (10KB)

Chapter 11: Hospital Services (122KB)

• Exhibit 11-1, Hierarchy for Processing Claims (20KB)
• Exhibit 11-2, Excluded Surgical Procedures (57KB)
• Exhibit 11-3, Outlier Calculation Worksheet (19KB)

Chapter 12: Pharmacy Services (82KB)

• Exhibit 12-1, RxAmerica Prior Authorization Request (43KB)

Chapter 13: DME and Supplies (33KB)

Chapter 14: Transportation Services (117KB)

Chapter 15: Dialysis Services (124KB)

Chapter 16: Free-Standing Ambulatory Surgery Centers (33KB)

Chapter 17: Free-Standing Birthing Centers (33KB)

Chapter 18: Emergency Services Program (45KB)

Chapter 19: Behavioral Health Services (88KB)

Chapter 20: Home Health Care Services (40KB)

Chapter 21: ALTCS Services (101KB)

• Exhibit 21-1, Sample ALTCS Authorization Letter (62KB)
• Exhibit 21-2, ALTCS Offices (43KB)

Chapter 22: Nursing Facility Services (68KB)

Chapter 23: Hospice Services (58KB)

Chapter 24: Transplants (44KB)

Chapter 25: Claims Processing (56KB)

Chapter 26: Correcting Claim Errors (146KB)

• Exhibit 26-1, Claim Correction Request Form (87KB)
• Exhibit 26-2, Claim Status Request Form (49KB)

Chapter 27: Understanding the Remittance Advice (265KB)

• Exhibit 27-1, Sample Remittance Advice - Address Page (70KB)
• Exhibit 27-2, Sample Remittance Advice - Financial Summary (80KB)
• Exhibit 27-3, Sample Remittance Advice - Paid Non-Facility Claims (81KB)
• Exhibit 27-4, Sample Remittance Advice - Denied Non-Facility Claims (81KB)
• Exhibit 27-5, Sample Remittance Advice - Adjusted Non-Facility Claims (81KB)
• Exhibit 27-6, Sample Remittance Advice - Voided Non-Facility Claims (81KB)
• Exhibit 27-7, Sample Remittance Advice - Non-Facility Claims in Process (80KB)
• Exhibit 27-8, Sample Remittance Advice - Processing Notes (80KB)
• Exhibit 27-9, Sample Remittance Advice - Paid Facility Inpatient Claims (81KB)
• Exhibit 27-10, Sample Remittance Advice - Paid Facility Outpatient Claims (101KB)
• Exhibit 27-11, Sample Remittance Advice - Denied Facility Claims (80KB)
• Exhibit 27-12, Sample Remittance Advice - Adjusted Facility Claims (81KB)
• Exhibit 27-13, Sample Remittance Advice - Voided Facility Claims (80KB)
• Exhibit 27-14, Sample Remittance Advice - Facility Claims in Process (80KB)

Chapter 28: Claim Disputes (55KB)

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