Provider Policy Manual

Providers-A

Health Choice Integrated Care Provider Policy Manual

HCIC Provider Policy Manual Crosswalk

Chapter 1  Introduction to Health Choice Integrated Care (UPDATE! July 2017)

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 (UPDATE! July 2017)

                2.1 Appointment Standards and Timeliness of Service (UPDATE! June 2017)

                2.2 Referral and Intake Process (UPDATE! August 2017)

                2.3 Outreach, Engagement, Re-engagement and Closure

                2.4  Assessment and Service Planning (UPDATE! September 2017)

                2.5  SMI Eligibility Determination  (UPDATE! September 2017)

                2.6 General and Informed Consent to Treatment (UPDATE! June 2017) 

                2.7 Pharmacy Management (UPDATE! August 2017)

                2.8 Pre-Petition Screening, Court-Ordered Evaluation, and Court-Ordered Treatment (UPDATE! August 2017)

                2.9 Special Populations – SABG and MHBG (UPDATE! June 2017)

                2.10 Crisis Intervention Services (UPDATE! July 2017)

                2.11 Housing for Individuals Determined to have SMI (UPDATE! July 2017)

                2.12 Special Assistance for Persons Determined to have SMI (UPDATE! August 2017)

                2.13 Arizona State Hospital

Chapter 3 Provider Responsibilities (UPDATE! June 2017)

                 3.1 Provider Deliverables and Business Continuity Plan (UPDATE! July 2017)

                  3.2 Member Choice and Intra-RBHA Transfers (UPDATE! July 2017)

Chapter 4 Covered Services (UPDATE! August 2017)

                  4.1 Maternity and Medically Necessary Pregnancy Terminations

                  4.2 Family Planning

                  4.3 Dental and Vision Services

                   4.4 Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Program

Chapter 5 Communication and Member Information (UPDATE! June 2017)

Chapter 6 Network Requirements

                    6.0 Provider Network Development and Management (UPDATE! August 2017)

                    6.1 Credentialing and Recredentialing Application Process  (UPDATE! July 2017)

                    6.2 Material Changes (UPDATE! July 2017)

                    6.3 Training Requirements (UPDATE! June 2017)

                    6.4.1 Peer Recovery Support Training Credentialing and Supervision Requirements (UPDATE! July 2017)

                    6.4.2 Parent and Family Support Training, Credentialing and Supervision Requirements (UPDATE! July 2017)

                    6.5 Cultural Competency (UPDATE! August 2017)

                    6.6 Out of State Placements  (UPDATE! July 2017)

                    6.7 Family and Youth Involvement in the Children’s Behavioral Health System (UPDATE! June 2017)

                    6.8 Use of Telemedicine (UPDATE! June 2017)

Chapter 7 Submitting Claims and Encounters (UPDATE! July 2017)

Chapter 8 Copayments and Other Member Fees (UPDATE! July 2017)

Chapter 9 Third Party Liability and Coordination of Benefits (UPDATE! July 2017)

Chapter 10 Covered Services Requirements

                   10.0 Advance Directives or End of Life Care (UPDATE! August 2017)

                   10.1 Medical Record Standards (UPDATE! August 2017)

 Chapter 11 Coordination of Care

                   11.1 Coordination of Care with AHCCCS Health Plans, PCPs and Medicare Providers (UPDATE! August 2017)

                   11.2 Coordination of Behavioral Health Care with other Governmental Entities (UPDATE! June 2017)

                   11.3 Coordination of Care for Referraks to In-Network Inpatient and Chemical Dependency (CD) Residential Facilities (Update! August 2017)

                   11.4 Coordination of Care for Members Who are Incarcerated

Chapter 12 Quality Management and Performance Improvement

                    12.0 Quality Management (UPDATE! July 2017)

                    12.1  Peer Review (UPDATE! June 2017)

Chapter 13  Service Authorization

                    13.0 Securing Services and Prior Authorization (UPDATE! August 2017)

                    13.1 Technology (UPDATE! July 2017)

                    13.2 Pre-Admission Screening and Resident Review (UPDATE! July 2017)

                    13.3 Concurrent Review (UPDATE! July 2017)

                    13.4 Discharge Planning (UPDATE! July 2017)

                    13.5 Retrospective Review (UPDATE! July 2017)

Chapter 14 Care Coordination

                   14.0 Case Management and Disease Management (UPDATE! June 2017)

                   14.1 Management (UPDATE! July 2017)

                   14.2 Health Risk Assessment  (UPDATE! June 2017)

Chapter 15 Service and Drug Utilization (UPDATE! June 2017)

Chapter 16 Contract Compliance

                    16.0 Confidentiality (UPDATE! June 2017)

                    16.1 Communication of System Changes and Program Requirements (UPDATE! July 2017)

                    16.2 Verification of US Citizenship or Lawful Presence for Public BH Benefits (UPDATE! July 2017)

                    16.3 Reporting Discovered Violations of Immigration Status (UPDATE! July 2017)

                    16.4  Duty to Report Abuse, Neglect or Exploitation (UPDATE! July 2017)

                    16.5 Duty to Warn (UPDATE! July 2017)

Chapter 17 Corporate Compliance

                   17.0 Corporate Compliance  (UPDATE! July 2017)

                   17.1 IHH/BHH and Other Provider Requirements (UPDATE! July 2017)

Chapter 18 Demographic and Other Member Data (UPDATE! August 2017)

Chapter 19 Reporting Requirements

                   19.0 Medical Institution Reporting of Medicare Part D (UPDATE! July 2017)

                   19.1 Reporting and Monitoring the Use of Seclusion and Restraint (UPDATE! July 2017)

                   19.2 Reporting of Incidents, Accidents and Deaths

                   19.3 Encounter Validation Studies (UPDATE! July 2017)

  Chapter 20 Grievance Systems and Member Rights

                   20.0 TITLE XIX and XXI Notice and Appeal Requirements (UPDATE! August 2017)

                   20.1 Complaint Resolution (UPDATE! August 2017)

                   20.2 Conduct of Investigations Concerning Persons with SMI (UPDATE! August 2017)

                   20.3 Notice and Appeal Requirements (SMI and Non-SMI Non-Title XIX/XXI) (UPDATE! August 2017)

                   20.4 Contractor and Provider Claim Disputes (UPDATE! August 2017)

Chapter 21 Financial Reporting Guide (UPDATE! July 2017)