1103.00 Enrollment with a Program Contractor

 

A. Program contractor responsibilities

 

The program contractor:

 


 

B. Who are the ALTCS program contractors?

 

There are three types of organizations that are program contractors:

 

AHCCCS currently has contracts with four  program contractors to provide ALTCS services to Elderly and/or Physically Disabled (EPD) customers, who are not enrolled with a tribal contractor. The contracts specify which county or counties each program contractor serves.

 

ALTCS EPD Program Contractor

Counties Served

Bridgeway Health Solutions

http://www.bridgewayhs.com

1501 W. Fountainhead Corporate Park, Suite 201

Tempe, AZ 85282

Toll free 1-866-475-3129

Cochise, Gila, Graham, Greenlee,  Maricopa, Pinal

Evercare Select

http://www.evercareselect.com/

AZ060-N120

3141 North 3rd Avenue

Phoenix, AZ 85013

(602) 331-5100

Toll free 1-800-293-3740

Apache, Coconino, La Paz, Maricopa, Mohave, Navajo, Pima, Santa Cruz, Yavapai, Yuma

Mercy Care Plan

http://www.mercycareplan.com

4350 E. Cotton Center Blvd. , Bldg D

Phoenix, AZ 85040

(602) 263-3000

Toll free 1-800-624-3879

Maricopa, Pima

SCAN Long Term Care

http://www.scanhealthplan.com/default.aspx

1313 E. Osborn Road, Suite 150

Phoenix, AZ 85014

(602) 778-3300

Toll free 1-888-540-7226

Maricopa

 

Note:  Effective October 1, 2011, enrollment is capped with no new persons being enrolled.

 


 

C. When does enrollment occur?

 

The effective date of enrollment is determined by the customer’s AHCCCS status on the date of approval.

 

IF the customer is

THEN ALTCS enrollment and capitation

Enrolled with an AHCCCS health plan at the time of approval

Begins on the date ALTCS approval is posted in PMMIS. The customer is disenrolled from the AHCCCS health plan the day before.

 

EXCEPTION: If the effective date of ALTCS eligibility is before the date the customer was enrolled with a health plan, the prior period begins on the first day of the ALTCS application (or the first eligible month) and ends on the day before the health plan enrollment began.

 

EXAMPLE:

Mrs. Y applied for ALTCS on March 25th. In April she was approved for SSI-MAO and was enrolled with a health plan effective April 1st. On May 7th her ALTCS application was approved effective March 1st. Mrs. Y is enrolled with a program contractor on May 7th and that program contractor is also responsible for prior period coverage from March 1st through March 31st. Her health plan enrollment is for the period of April 1st to May 6th.

Not enrolled with an AHCCCS health plan

Is retroactive to the effective date of eligibility (prior period coverage).

 

EXAMPLE:

Mr. D applied for ALTCS on January 17th. On March 3rd his application was approved effective January 1st. The prior period begins on January 1st and ends on March 2nd.

 


 

D. What happens after enrollment?

 

After enrollment occurs: