AHCCCS IHS/Tribal Provider Billing Manual

The AHCCCS Billing Manual for Indian Health Services (IHS)/Tribal Providers contains information ranging from introductory information about AHCCCS to claim disputes.

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Billing Manual for IHS/Tribal Providers [2.9MB]

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Manual Table of Contents [52KB]
Chapter 1: Introduction to AHCCCS [130KB]
- Exhibit 1-1, AHCCCS Acute Care Health Plans [56KB]
- Exhibit 1-2, AHCCCS Long Term Care Program Contractors [60KB]
- Exhibit 1-3, Indian Health Services [IHS] Offices [41KB]
- Exhibit 1-4, Help Line Directory [43KB]
Chapter 2: Eligibility [57KB]
Chapter 3: Provider Records and Registration [99KB]
Chapter 4: General Billing Rules [135KB]
Chapter 5: Claim Form Requirements [1.5MB]
Chapter 6: Authorization/Referrals [39KB]
Chapter 7: Medicare/Other Insurance Liability [163KB]
Chapter 8: Individual Practitioner Services [221KB]
- Exhibit 8-1, Hysterectomy Consent Form [10KB]
Chapter 9: Hospital and Clinic Services [103KB]
Chapter 10: Pharmacy Services [80KB]
- Exhibit 10-1, RxAmerica Prior Authorization Request [43KB]
Chapter 11: Transportation Services [69KB]
- Exhibit 11-1, Transportation Prior Authorization Request Form [85KB]
Chapter 12: Behavioral Health Services [90KB]
Chapter 13: Home Health Care Services [40KB]
Chapter 14: ALTCS Services [125KB]
- Exhibit 14-1, Sample ALTCS Authorization Letter [79KB]
- Exhibit 14-2, ALTCS Offices [37KB]
Chapter 15: Nursing Facility Services [72KB]
Chapter 16: Claims Processing [53KB]
Chapter 17: Correcting Claim Errors [153KB]
- Exhibit 17-1, Claim Correction Request Form [87KB]
- Exhibit 17-2, Claim Status Request Form [48KB]
Chapter 18: Understanding the Remittance Advice [340KB]
- Exhibit 18-1, Sample Remittance Advice - Address Page [182KB]
- Exhibit 18-2, Sample Remittance Advice - Financial Summary [80KB]
- Exhibit 18-3, Sample Remittance Advice - Paid Non-Facility Claims [81KB]
- Exhibit 18-4, Sample Remittance Advice - Denied Non-Facility Claims [80KB]
- Exhibit 18-5, Sample Remittance Advice - Adjusted Non-Facility Claims [81KB]
- Exhibit 18-6, Sample Remittance Advice - Voided Non-Facility Claims [80KB]
- Exhibit 18-7, Sample Remittance Advice - Non-Facility Claims in Process [80KB]
- Exhibit 18-8, Sample Remittance Advice - Processing Notes [80KB]
- Exhibit 18-9, Sample Remittance Advice - Paid Facility Inpatient Claims [81KB]
- Exhibit 18-10, Sample Remittance Advice - Paid Facility Outpatient Claims [172KB]
- Exhibit 18-11, Sample Remittance Advice - Denied Facility Claims [80KB]
- Exhibit 18-12, Sample Remittance Advice - Adjusted Facility Claims [80KB]
- Exhibit 18-13, Sample Remittance Advice - Voided Facility Claims [80KB]
- Exhibit 18-14, Sample Remittance Advice - Facility Claims in Process [80KB]
Chapter 19: Claim Disputes [71KB]

Contact

For further information, contact the Division of Fee-For-Service Management Outreach & Planning Manager.

Call: 602-417-4175
Email: Bruce.Jameson@azahcccs.gov