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Quality Improvement Program

AHCCCS has set goals for health plans. AHCCCS does a survey to see how well health plans are providing services against access to care and use of preventive services goals.

AHCCCS wants to know how happy their members are with their AHCCCS plan, the care they receive, and their doctor. Below is the latest member and provider satisfaction surveys.

Arizona Complete Health-Complete Care Plan Internal Performance Measure Results

Arizona Complete Health-Complete Care Plan 11/04/2020 Provider Forum Feedback Survey

Q1: I represent a__________________________ provider.

  • Primary Care – 1 response
  • Specialty Care – 3 responses
  • Ancillary Care – 0 responses
  • Hospital Health System – 2 responses
  • FQHC – 0 responses
  • Health Home – 2 responses
  • Behavioral Health – 1 responses
  • Other (please specify) – 0 responses

Q2: How would you rate the presentation overall?

  • Excellent – 1 response
  • Good – 7 responses
  • Fair – 1 response
  • Poor – 0 responses
  • Total – 9 responses

Q3 How would you rate the presenters?

  • Excellent – 3 response
  • Good – 5 responses
  • Fair – 1 response
  • Poor – 0 responses
  • Total – 9 responses

Q4: Do you think the Provider Forum presentation adds value to the services you provide to your members?

  • Yes – 3 responses
  • No – 2 responses
  • Please elaborate if you would like to:
  • The education on what the health plan expects from the provider is very helpful.
  • as a specialty provider it's good to know what else AzCH is striving for.
  • 3 There is a lot of information that is provided in these forums and it involves 2 hours of our time for different types of providers to listen to each section that may or may not pertain to our purpose of business. It would be better if there were Forums for specific topic that would only last about an hour which included Q&A. There are many other Insurances that hold specific forums and it creates a small audience for those wanting to learning on the specific topic. 2hours is a long time to listen when your topic is at the end.

Q5 Does this Provider Forum contribute to your overall Satisfaction with Arizona Complete Health-Complete Care Plan?

  • Yes it does
  • no.
  • Some what
  • It is a great feature, but it does not resolve the issues with some of the processes for AzCH.
  • Yes
  • yes
  • A little bit.
  • I am looking for specific information provided to me as a home health agency reimbursement position. Such as timely filing, claims processing, COB issues, appeal process, refund process etc..
  • no
  • Total – 9 resposnes

Q6 What did you like best about the presentation?

  • Claims
  • nothing
  • Claims section
  • It was interesting and actually a relief, that some of the other practices gave the same feedback about the processes, i.e. Prior Authorization, it has been so frustrating. It isn't solved, but it really was validating for me because NIA is not at all easy to work with.
  • Educational value
  • Easy to understand
  • Walking through some part of the contract where the most irregularities occur.
  • the interaction to get the audience involved. Presenters are very knowledgeable in their fields
  • the prizes
  • Total – 9 responses

Q7: How do you think the presentation can be improved?

  • More information concerning Behavioral Health Specialty Providers and claim submission.
  • cancelled
  • N/A
  • I am not sure, this was my first time attending. It was quite a bit of information, that is good!
  • Since we are radiation oncology/hematology/medical oncology and general surgery I would like more information directed to the different specialties.
  • n/a
  • use Audit results to determine topics.
  • they do an awesome job but I would hope in the future that the Forums would be on a more specific subject and only an hour instead of 2 hour for all issues covered
  • address claims appeals
  • Total – 9 responses

Q8: Topics you would like to learn more about:

  • Claims – 8 responses
  • Grievance and Appeals – 6 responses
  • Prior Authorization – 2 responses
  • Credentialing – 2 responses
  • Care/Case Management – 1 response
  • Other (Please specify)
  • None
  • Chemo Drug education
  • I do think that there are some improvements need to the claim checking and reconsideration process

Arizona Complete Health-Complete Care Plan June 2019 Forum Survey

Q1: In which county and on what date did you attend a forum?

  • Pima: 6 responses
  • Maricopa: 4 responses
  • Total: 10 responses

Q2: How would you rate the presentation overall?

  • Excellent: 2 responses
  • Good: 4 responses
  • Average: 2 responses
  • Poor: 3 responses
  • Very Poor: 0 responses
  • Total: 11 responses

Q3: How would you rate the presenters?

  • Excellent: 1 responses
  • Good: 5 responses
  • Average: 3 responses
  • Poor: 1 responses
  • Very Poor: 0 responses
  • Total: 10 responses

Q4: Did the presentation meet the stated objectives?

  • Excellent: 3 responses
  • Good: 2 responses
  • Average: 4 responses
  • Poor: 1 responses
  • Very Poor: 2 responses
  • Total: 11 responses

Q5: Do you think the Provider Forum presentation adds value to the services you provide to your clients?

  • Excellent: 3 responses
  • Good: 4 responses
  • Average: 1 responses
  • Poor: 2 responses
  • Very Poor: 1 responses
  • Total: 11 responses

Q6: How many families/children do you expect to share this information with throughout the next month?

  • Families Average: 28
  • Children Average: 18
  • Total: 8 responses

Q7: What did you like best about the presentation?

  • The opportunity to meet the staff for Arizona Complete Health
  • Very informative and presentation included a lot of data
  • Seeing people face to face
  • Connection w/ provider engagement rep
  • Up to date information on what is expected from providers at this time from RBHA
  • Total: 5 responses

Q8: How can the presentation be improved?

  • I think giving more opportunity for provider feedback would be helpful
  • Focus specifically on the needs of the providers. Much of the information was repeated from other presentations.
  • Agenda and opportunities for questions and discussion
  • As we are checking in, a sheet should be given listing the Providers/Facilities attending and who their Provider Rep is and where they will be sitting so we may meet them in person
  • It would have been nice to have a presenter on billing/claims/appeals
  • You should show the providers what you plan to do to correct the issues we are having. Like claims not being paid
  • State the populations that data is being reviewed for
  • Total: 7 responses

Q9: Topics you would like to learn more about

  • I think reviewing different parts of the provider manual that seem to be most difficult would be a good use of the time in these forums.
  • We would like to learn more about that the Health Home model looks like for your health plan
  • How to connect with AzCH and how to get problems resolved
  • Why claims are not paid!
  • 5 More information on COE and COT expectations from RBHA
  • Total responses: 5

Arizona Complete Health-Complete Care Plan Provider Forum May 2020 Feedback Survey

Q1: I am a __________________________ provider.

  • Primary Care – 3 responses
  • Specialty Care – 17 responses
  • Ancillary Care – 3 responses
  • Total – 23 responses

Q2: How would you rate the presentation overall?

  • Excellent – 3 responses
  • Good – 10 responses
  • Fair – 9 response
  • Poor – 1 response
  • Total – 12 responses

Q3: How would you rate the presenters?

  • Excellent – 4 responses
  • Good – 10 responses
  • Fair – 8 response
  • Poor – 1 response
  • Total – 23 responses

Q4: Do you think the Provider Forum presentation adds value to the services you provide to your members?

  • Yes – 17 responses
  • No – 6 responses
  • Total – 23 responses

Q5: Does this Provider Forum contribute to your overall Satisfaction with Arizona Complete Health-Complete Care Plan?

  • No
  • Yes
  • need more coding info
  • No. You guys still have a lot of issues to work out.
  • Yes
  • No we still have to many system errors we are waiting on correction in order to get reimbursed, and once one issue is resolved have more to work on.
  • N A
  • Yes it makes me feel you care.
  • I am always confused at who these meetings are trying to target. The information is all of the may from program level to mid management to CEO...seems like we get very little for the time spent.
  • yes
  • marginally - very canned presentation that is run through very, very quickly via reading a script.
  • Yes
  • yes
  • YES
  • same as above
  • No
  • Due to unpaid claims current satisfaction level is low, these are the behaviors and communications that change that so yes.
  • It helps.
  • no
  • No, only because I was hoping this was a hospital forum. Any idea if you will be holding a session for hospitals
  • No - this was a waste of time
  • Yes
  • No
  • Total – 23 responses

Q6: What did you like best about the presentation?

  • Handouts
  • Virtual
  • clear
  • easy to understand presentation.
  • The ability to bounce ideas and questions off of the health plan
  • Appeals but I would like a way to contact them
  • NA
  • over all information.
  • nothing
  • How the pre-cert works
  • Well intended, but not very engaging.
  • Detail process and forms
  • clear and concise
  • all the presentation
  • no dental mention
  • Telehealth POS and Modifiers needed
  • A lot of info but well organized so many different types of providers were able to get something out of the forum
  • The information provided.
  • The fact that we didn't have to travel 100 miles roundtrip to attend! :)
  • That I was able to write notes on the webinar that caught the attention of AZ Complete management and that they are willing to communicate with me and hopefully help us with unaddressed issues.That is wrapped up early
  • Very thorough
  • Appreciate the actual leadership participating instead of proxies
  • Total – 23 responses

Q7: How do you think the presentation can be improved?

  • Don’t read us the power point. The speakers should just point out the highlights and the action steps. I hate to be read to in a meeting, as a waste of everyone’s time. T
  • Dont read to us
  • more coding for telehealth
  • N/A
  • More information regarding the merger of AZCH and Care 1st
  • I like to see more resolution
  • NA
  • Some of it was not anything I would need to know but I do need to understand that it may have been relevant to other people.
  • More current and specific info for CEO Level.
  • Maybe a little more attentions to specific services, some are kind of vague.
  • Slow down and allow for more interaction with the audience. Again, this was very script oriented and it felt like each presenter talked faster and faster.
  • increase detail review of process
  • I prefer in person training but for short presentations I understand it's unrealistic.
  • I think it is okay
  • speak on dental and medical the 2 relate to overall health of the patient its not just medical
  • talking more about claims and appeals
  • Separate forums by provider type/line of business to really hammer in on where there are still issues
  • Monthly updates.
  • Send the powerpoint presentation in advance, and let the providers read it. So much time is wasted listening to AzCH staff read the powerpoint to us, there is little time for questions/comments. We can read! And as always, claims/payments are left for the last 9 minutes, when those are the big issues providers would like to address. It would be great to see more (live) discussion, and real answers to questions, rather than promises of "we'll get back to you". The format of the forums has not really changed since the Cenpatico days. I appreciate the opportunity to be frank about my opinion! Thank you.
  • Give facilities a presentation of what you are doing to improve that will benefit the hospitals and plan relationships. My personal experience is that AZ Complete is not responsive to my concerns. I hear this from my colleagues at other hospitals as well.
  • Be more engaging- from this side it feels like the presenters are competing on who can speak the fastest and click thru their presentation without questions. Very stiff and not genuine in delivery.
  • Spend more time on Justice involved and TIP program information.
  • Less spin and more candid conversation
  • Total – 23 responses

Q8 Topics you would like to learn more about:

  • Claims – 18 responses
  • Grievance and Appeals – 9 responses
  • Prior Authorization – 7 responses
  • Credentialing – 8 responses
  • Case/Care Management – 6 responses
  • Other (PLEASE SPECIFY) – 5 responses
  1. quality metrics, ways for specialty providers to see how we are benchmarking with others
  2. All areas, I would like better communication with all departments in order to provide quality services to AZCH members in a timely fashion. Issues with the claims and PA departments is ongoing along with a non-existent line of communication with the appeals department and work flow. Please reach out to the provider representative to be more engaged with the providers.
  3. Your presentation is specific and to the point.
  4. I will probably not be involved in future forums, but I do appreciate the opportunity to provide input.
  5. Justice Involved and TIP Programs

Arizona Complete Health-Complete Care Plan November 2019 Forum Survey

Q1: In which county and on what date did you attend a forum?

  • Pima – 4 responses
  • Maricopa – 10 responses
  • Yuma – 5 responses
  • Total – 19 responses

Q2: How would you rate the presentation overall?

  • Excellent – 4 responses
  • Good – 8 responses
  • Average – 5 responses
  • Poor – 2 responses
  • Very Poor – 0 responses
  • Total – 19 responses

Q3: How would you rate the presenters?

  • Excellent – 4 responses
  • Good – 8 responses
  • Average – 6 responses
  • Poor – 1 responses
  • Very Poor – 0 responses
  • Total – 19 responses

Q4: Did the presentation meet the stated objectives?

  • Excellent – 2 responses
  • Good – 9 responses
  • Average – 7 responses
  • Poor – 0 responses
  • Very Poor – 1 responses
  • Total – 19 responses

Q5: Do you think the Provider Forum presentation adds value to the services you provide to your clients?

  • Excellent – 6 responses
  • Good – 2 responses
  • Average – 5 responses
  • Poor – 5 responses
  • Very Poor – 0 responses
  • Total – 18 responses

Q6: How many families/children do you expect to share this information with throughout the next month (estimate)?

  • Families – Average 26
  • Children – Average 6
  • Total – 14 responses

Q7: What did you like best about the presentation?

  • the credentialing directors "I can do better"
  • The ability to have interactive responses
  • I thought that the WIC and AHA presentations had a lot of good information to share with
  • patients and providers. I wish the AHA had spent more time going over their presentation and
  • what they had to offer to practices.
  • The honesty and straight forwardness of the issues.
  • PRESENTERS WANTED THE FEED BACK
  • Everything
  • Very informative
  • The investment in the community and transparency
  • Billing and AHA and Lunch
  • It was not a forum that helped anyone. All it was, was the insurance company making excuses for things not being done. I learned nothing. I knew more about somethings than some of the presenters knew. Customer reps need to be taught way better to answer questions and let providers talk to the authorization department when we need to.
  • Set up, location, food. Courteous 
  • Up front and honest about sanctions, issues affecting Az Complete
  • Total – 12 responses

Q8: How can the presentation be improved?

  • more emphasis on AZ CH and how to work better with you vs having the outside parties present most of the forum
  • There be a bit more resolve and have individuals available that make decisions.
  • Focus more on issues with billing, claims, credentialing
  • Going step by step through a PDF on referrals was very hard to get through. It felt like this would have been better served as a handout and an offer to help anyone who had questions, afterward.
  • Having them more often.
  • Tailor presentation to the departments or roles of staff attending. The people attending this meeting are not the ones putting PAs into the AzCH portal
  • NEED TO HAVE ANSWERS FOR ALL TYPES OF DOCTORS, AND GET YOUR NAME AND AT LEAST PHONE NUMBER TO CALL BACK WITH AN ANSWER. NO ONE ASKED FOR THIS INFORMATION OR MAKE SURE THAT YOU UNDERSTOOD THIS SO YOU KNEW WHO TO CONTACT
  • none
  • N/A
  • Can't think of anything at the moment.
  • Agenda or schedule of each session would be nice. Some don't apply to me but I sit through them because I don't know the agenda for the day.
  • Educate your customer service reps. And let providers talk to who they need to talk to like the authorization department, Because the reps know nothing about authorizations. They waste our time and we are busy with our patients.
  • ACH can probably be a bit better prepared in relation to consistent provider concerns as the tale end of the meeting was a complaint session with very little traction on resolution especially related to claims and or payor portal. It is also important to keep the speakers on time as the late speaker (s) were at a disadvantage given half the audience started to leave given time for conference had ended per schedule.
  • AWC is a bit far and out of the way for most medical offices, possibly more center of town.
  • Total – 14 responses

Q9 Topics you would like to learn more about:

  • Community resources for clients all types, housing for both smi and gmhsa, children's services, community based services not connected to health plans.
  • billing, claims, credentialing
  • I was really interested in the BP AHA conversation.
  • NA
  • MORE FORUMS TO KEEP THE PROVIDERS UP TO DATE THIS SHOULD BE FOR ALL ON THE PRODUCT LINE OF CENTENE
  • claims and credentialing
  • How my provider rep can increase in communication with our practice. We still have not heard from our provider rep as she promised.
  • Billing Denials
  • Billing policies, medical policies, processes. 
  • Clarify ahcccs to your reps. NO Allergy Coverage for patients over 21.. They tell pcps and patients it is a covered service and then they get upset with us when we tell them it is not covered. They say then why did my pcp refer me to your office.. A lot of pcp office also do not know the guidelines for allergy specialists. Please educate them too. You would have happier patients and doctors.
  • Claims process and common errors which can impact any backlogs for ACH and or payors. How can we all work together to make these a smoother process?
  • 12 n/a
  • Total – 12 responses