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.

Download Entire Manual [Zip]

• Billing Manual for IHS/Tribal Providers [3.21MB]

Download Individual Chapters [PDF]

• Manual Table of Contents [157KB]
• Chapter 1: Introduction to AHCCCS [97KB]
  • Exhibit 1-1, AHCCCS Acute Care Health Plans
  • Exhibit 1-2, AHCCCS Long Term Care Program Contractors
  • Exhibit 1-3, Indian Health Services [IHS] Offices
  • Exhibit 1-4, Help Line Directory
• Chapter 2: Eligibility [56KB]
• Chapter 3: Provider Records and Registration [99KB]
• Chapter 4: General Billing Rules [135KB]
• Chapter 5: Claim Form Requirements [149KB]
• Chapter 6: Authorization/Referrals [36KB]
• Chapter 7: Medicare/Other Insurance Liability [163KB]
• Chapter 8: Individual Practitioner Services [428KB]
  • Exhibit 8-1, Hysterectomy Consent Form
• Chapter 9: Hospital and Clinic Services [66KB]
• Chapter 10: Pharmacy Services [348KB]
  • Exhibit 10-1, MedImpact Prior Authorization Request [78KB]
• Chapter 11: Transportation Services [92KB]
  • 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 [122KB]
  • Exhibit 14-1, Sample ALTCS Authorization Letter
  • Exhibit 14-2, ALTCS Offices
• Chapter 15: Nursing Facility Services [62KB]
• Chapter 16: Claims Processing [41KB]
• 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]