AHCCCS IHS/Tribal Provider Billing Manual

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

Download Entire Manual

The IHS/Tribal Provider Billing Manual is intended to outline billing requirements for providers who are billing the AHCCCS IHS/Tribal unit for reimbursement.

This is a Master PDF that contains all chapters of the IHS/Tribal Provider Billing Manual and its corresponding exhibits.

• IHS/Tribal Provider Billing Manual - Master PDF
  * Master pdf is currently undergoing revisions - please see individual chapters for more accurate and up to date information

Download Individual Chapters

• Manual Table of Contents  
• Chapter 1:  Introduction to AHCCCS
  • 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
• Chapter 3:  Provider Records and Registration
• Chapter 4:  General Billing Rules
• Chapter 5:  Claim Form Requirements
• Chapter 6:  Prior Authorizations
• Chapter 7:  Medicare/Other Insurance Liability
• Chapter 8:  Individual Practitioner Services
  • Exhibit 8-1, Hysterectomy Consent Form
  • Exhibit 8-2, Participating Provider
• Chapter 9:  Hospital and Clinic Services
• Chapter 10:  Pharmacy Services
  • Exhibit 10-1,  OptumRX Prior Authorization Request Form
• Chapter 11:  Transportation Services
  • Exhibit 11-1,  Daily Trip Report (PDF)
  • Exhibit 11-1,  Daily Trip Report (Excel File)
  • Exhibit 11-2,  Non-emergency Medical Transport Daily Trip Report Instructions
  • Exhibit 11-3,  Tribal Contact Information
  • Exhibit 11-4,  Public Transportation Pass Form
• Chapter 12:  Behavioral Health Services
• Chapter 13:  Home Health Care Services
• Chapter 14:  ALTCS Services
  • Exhibit 14-1, Sample ALTCS Authorization Letter
  • Exhibit 14-2, ALTCS Offices
• Chapter 15:  Nursing Facility Services
• Chapter 16:  Claims Processing
• Chapter 17:  Correcting Claim Errors
• Chapter 18:  Understanding the Remittance Advice
  • Exhibit 18-1,  Sample Remittance Advice - Address Page
  • Exhibit 18-2,  Sample Remittance Advice - Financial Summary
  • Exhibit 18-3,  Sample Remittance Advice - Paid Non-Facility Claims
  • Exhibit 18-4,  Sample Remittance Advice - Denied Non-Facility Claims
  • Exhibit 18-5,  Sample Remittance Advice - Adjusted Non-Facility Claims
  • Exhibit 18-6,  Sample Remittance Advice - Voided Non-Facility Claims
  • Exhibit 18-7,  Sample Remittance Advice - Non-Facility Claims in Process
  • Exhibit 18-8,  Sample Remittance Advice - Processing Notes
  • Exhibit 18-9,  Sample Remittance Advice - Paid Facility Inpatient Claims
  • Exhibit 18-10,  Sample Remittance Advice - Paid Facility Outpatient Claims
  • Exhibit 18-11,  Sample Remittance Advice - Denied Facility Claims
  • Exhibit 18-12,  Sample Remittance Advice - Adjusted Facility Claims
  • Exhibit 18-13,  Sample Remittance Advice - Voided Facility Claims
  • Exhibit 18-14,  Sample Remittance Advice - Facility Claims in Process
• Chapter 19:  Claim Disputes
• Chapter 20:  638 FQHC