For Providers

Providing Care

Whether you are initiating care or providing ongoing treatment, obtaining authorizations and utilizing appropriate clinical protocols are essential to the delivery of quality care.

Online tools for providers

By signing in to the Magellan provider website with your secure username and password, you can view authorizations, check member eligibility and much more. You also can update your practice data so that Magellan can provide the most accurate information when making member referrals.

AHCCCS Non-Emergency Medical Transport Providers--Taxi Copayment Requirements Effective April 1, 2012

The Federal Centers for Medicare and Medicaid Services (CMS) recently approved a $2.00 mandatory copayment for taxi services per one-way trip for certain AHCCCS members residing in urban counties. This memorandum provides general information regarding this copayment requirement that will become effective April 1, 2012. A sample table with copayment information for AHCCCS members accompanies this memo.

AHCCCS members who will have mandatory copayments for taxi services beginning April 1, 2012 are:

Childless Adults (in the table, the Childless Adult population is designated as member Copay Level of 40):
- who reside in Maricopa and Pima Counties, and
- who are aged 19 and older, and
- who are enrolled in an AHCCCS Health Plan

["Childless Adults" are also referred to as "AHCCCS Care" or the "TWG (Title XIX Waiver Group) Population."]

Providers impacted by this mandatory copayment include those who provide transportation via a "taxi," which is defined as a vehicle that has been issued a taxi special license plate pursuant to A.R.S. § 28-2515.

Mandatory copayments permit providers to deny services to members who do not pay the $2.00 copayment. The $2.00 copayment will be charged each time a taxi is called. If a taxi waits for a member, e.g., while the member picks up a prescription, then a $2.00 co-pay cannot be charged for the continuation of the one-way trip. Specific members are exempt from copayments, for example, persons determined to be Seriously Mentally Ill (SMI) by the Arizona Department of Health Services (in the table, exempt members are designated as a Member Copay Level of 00). Please be aware that payments to providers will be reduced by the amount of a member's copayment obligation regardless of whether or not the provider successfully collects the mandatory copayment.

AHCCCS' Managed Care Organizations primarily contract with one transportation brokerage for transportation services. In this case, the brokerage will notify their taxi drivers when an AHCCCS member approved for taxi services is a Childless Adult who is subject to the $2.00 per one-way copayment. Contractors who do not have an exclusive arrangement with a transportation brokerage will directly provide the notification of a copayment requirement to the transportation provider when scheduling the transportation for the member.

Resources:

Visit http://www.azahcccs.gov/commercial/providerbilling/copayments.aspx for more information regarding this taxi copayment, as well as copayments for other AHCCCS services can be found at
Click HERE to veiw the Non-Emergency Medical Transport CoPays document
Provider communications on this requirement:
- Taxi Copayment Requirements Effective April 1, 2012
- Clarification: Taxi Copayment Requirements

Important Changes to AHCCCS--MVD Photos Added To AHCCCS Online Eligibility Verification

Effective Thursday, Dec. 15, 2011, AHCCCS will be adding photos to its online verification tool that providers use to verify member eligibility. This new feature is one of many efforts by AHCCCS to help protect members and prevent fraud. AHCCCS will obtain photos from the Arizona Department of Transportation Motor Vehicle Division (MVD) of all AHCCCS members who have an Arizona driver's license or a State issued Identification (ID) Card. When providers use the online member verification system and enter a member's social security number, the member's photo, if available from MVD, will be displayed on the AHCCCS eligibility verification screen along with other AHCCCS coverage information. The added photo image will assist AHCCCS providers to quickly validate the identity of a member.

Member Notice: AHCCCS members will be notified of this change through the member portals on the AHCCCS internet website. AHCCCS and its Contractors will also notify members via newsletters and the handbooks. In the future, members will be informed about the addition of MVD photos on their AHCCCS ID card carriers as well as in the Welcome Back letters.

Provider Information/Requirements: Providers are reminded of their continuing obligation to comply with all requirements of the AHCCCS Provider Participation Agreement as a condition of participating in the AHCCCS Program. Paragraph 25 of the Agreement states: "If Provider or any employee or contractor of Provider discovers, or is made aware, that an incident of potential fraud or abuse has occurred, the Provider shall report the incident to the AHCCCS Office of Inspector General (AHCCCS OIG) in accordance with state statutes and AHCCCS policy."

In addition, Arizona Laws ARS §§ 36-2905.04 and 2918.01 require providers to cooperate with AHCCCS to prevent and discover eligibility fraud and to immediately notify AHCCCS of any cases of suspected fraud or abuse.

For the latest information regarding this change, please visit AHCCCS' news and upate portal at http://azahcccs.gov/shared/news.aspx (refer to second bullet on MVD change).

Health-e-Arizona training

AHCCCS provides monthly training to the community on different topics that may be useful to subscribers of their Health-e-Arizona system. The Health-e-Arizona system is an electronic system that allows recipients to apply for AHCCCS benefits online. Click here to view a webinar on "Applying for SMI Applicants Using Health-e-Arizona." Users who have logged into Health-e-Arizona can find the list of upcoming webinars on the Health-e-Arizona site. Select "Links and Contacts" and then "HEALTH-E-ARIZONA 2011 TRAINING."

Medical necessity criteria

Clinical guidelines

Single points of contact for clinical coordination

GMHSA provider single point of contact grid (Updated: 09-23-11)

Directory of Women's Treatment Services

Directory of Women's Treatment Services (Updated 08-08-11)
Directory of Women's Treatment Services (Spanish) (Updated 09-08-11)

Clinical monographs

The following clinical monographs are available to download.

Prevention resources

Access to interpretation services

Magellan language service vendor directory (77KB, Oct. 2011)
Interpretation service flow chart (18K)
Web site access to qualified interpreters (39K)
Interpreter request form (11K)

Error resolution guide

Error resolution guide (141K Updated: 07-11-11)

Adobe Reader is required to view PDF files.

Word Viewer is required to view DOC files.

If you have any questions about your services, please call Magellan at (800) 564-5465, TTY (800) 424-9831. If you are in crisis, call the Maricopa Crisis Line at (800) 631-1314, TTY (800) 327-9254. For emergencies, please always dial 911.

This page last updated: Monday, March 26, 2012.