Provider Policy Manual

 

View the continuous PDF of the Provider Manual and the Crosswalk:

 

Health Choice Integrated Care Provider Policy Manual

Chapter 1  Introduction to Health Choice Integrated Care 

Chapter 2 Network Provider/Service Delivery Requirements

2.0 Eligibility Screening for AHCCCS Health Insurance, Medicare Part D Prescription Drug Coverage

                       and Low Income Subsidy Program

                2.1 Appointment Standards and Timeliness of Service

                2.2 Referral and Intake Process

                2.3 Outreach, Engagement, Re-engagement and Closure

                2.4  Assessment and Service Planning

                2.5  SMI Eligibility Determination 

                2.6 General and Informed Consent to Treatment

                2.7 Pharmacy Management

                2.8 Pre-Petition Screening, Court-Ordered Evaluation, and Court-Ordered Treatment

                2.9 Special Populations – SABG and MHBG

                2.10 Crisis Intervention Services

                2.11 Housing for Individuals Determined to have SMI

                2.12 Special Assistance for Members Determined to have SMI

                2.13 Arizona State Hospital

Chapter 3 Provider Responsibilities 

                 3.1 Provider Deliverables and Business Continuity Plan

                  3.2 Member Choice and Intra-RBHA Transfers

Chapter 4 Covered Services

                  4.1 Maternity and Medically Necessary Pregnancy Terminations (UPDATE! June 2018)

                  4.2 Family Planning (UPDATE! June 2018)

                  4.3 Dental and Vision Services

                   4.4 EPSDT Program (UPDATE! May 2018)

                   4.5 Women’s Preventive Care (UPDATE! June 2018)

Chapter 5 Communication and Member Information 

Chapter 6 Network Requirements

                    6.0 Provider Network Development and Management 

                    6.1 Credentialing and Recredentialing Application Process 

                    6.2 Material Changes

                    6.3 Training Requirements

                    6.4.1 Peer Recovery Support Training Credentialing and Supervision Requirements

                    6.4.2 Parent and Family Support Training, Credentialing and Supervision Requirements 

                    6.5 Cultural Competency

                    6.6 Out of State Placements  

                    6.7 Family and Youth Involvement in the Children’s Behavioral Health System

                    6.8 Use of Telemedicine

Chapter 7 Submitting Claims and Encounters 

Chapter 8 Copayments and Other Member Fees

Chapter 9 Third Party Liability and Coordination of Benefits 

Chapter 10 Covered Services Requirements

                   10.0 Advance Directives or End of Life Care

                   10.1 Medical Record Standards

 Chapter 11 Coordination of Care

                   11.0  Inter-RBHA Coordination of Care

                   11.1 Coordination of Care with AHCCCS Health Plans, PCPs and Medicare Providers

                   11.2 Coordination of Behavioral Health Care with other Governmental Entities

                   11.3 Coordination of Care for Referrals to In-Network Inpatient and Chemical Dependency (CD) Residential Facilities

                   11.4 Coordination of Care for Members Who are Incarcerated

Chapter 12 Quality Management and Performance Improvement

                    12.0 Quality Management

                    12.1  Peer Review

Chapter 13  Service Authorization

                    13.0 Securing Services and Prior Authorization

                    13.1 Technology

                    13.2 Pre-Admission Screening and Resident Review

                    13.3 Concurrent Review

                    13.4 Discharge Planning

                    13.5 Retrospective Review

Chapter 14 Care Coordination

                   14.0 Case Management and Disease Management

                   14.1 Management

                   14.2 Health Risk Assessment

Chapter 15 Service and Drug Utilization

Chapter 16 Contract Compliance

                    16.0 Confidentiality

                    16.1 Communication of System Changes and Program Requirements

                    16.2 Verification of US Citizenship or Lawful Presence for Public BH Benefits

                    16.3 Reporting Discovered Violations of Immigration Status

                    16.4  Duty to Report Abuse, Neglect or Exploitation

                    16.5 Duty to Warn

Chapter 17 Corporate Compliance

                   17.0 Corporate Compliance

                   17.1 IHH/BHH and Other Provider Requirements

Chapter 18 Demographic and Other Member Data

Chapter 19 Reporting Requirements

                   19.0 Medical Institution Reporting of Medicare Part D

                   19.1 Reporting and Monitoring the Use of Seclusion and Restraint

                   19.2 Reporting of Incidents, Accidents and Deaths

                   19.3 Encounter Validation Studies

  Chapter 20 Grievance Systems and Member Rights

                   20.0  TITLE XIX and XXI Notice and Appeal Requirements

                   20.1 Complaint Resolution

                   20.2 Conduct of Investigations Concerning Persons with SMI

                   20.3 Notice and Appeal Requirements (SMI and Non-SMI Non-Title XIX/XXI)

                   20.4 Contractor and Provider Claim Disputes

Chapter 21 Financial Reporting Guide