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AzCH Payment Integrity Correct Coding and Policy Updates

Date: 04/15/21

Please review the following three updates regarding claims processing and payments from Arizona Complete Health (AzCH). Note that effective dates for each update may differ.

UPDATE #1 - TELEHEALTH BYPASS REMOVAL

AzCH employs pre-pay correct coding claims logic, which has historically (pre-pandemic) been applied to telehealth claims in the same way it is applied to face-to-face services. For a time, AzCH implemented a bypass of this editing for services billed with a telehealth place of service or with a telehealth modifier.

Effective May 15, 2021, AzCH will resume pre-pay correct code editing for services billed with a telehealth place of service or modifier(s) consistent with the editing in place for in person services. This change will pertain to applicable Medicaid, Marketplace and Medicare claims.

UPDATE #2 - DIAGNOSES ADDED TO EMERGENCY DEPARTMENT LEVELING POLICY

AzCH payment policy CC.PP.053 is currently implemented for all lines of business. However, this past year, certain non-emergency diagnosis codes were removed from being subject to the policy.

Effective May 15, 2021, the non-emergency diagnosis codes included in the table below will be subject to the policy. This change will be effective for dates of service on and after May 15, 2021 for applicable Medicaid, Marketplace, and Medicare claims.

  • R50.0- Fever Unspecific
  • Z20.828- Contact exposure other viral communicable disease
  • Z30.818- Encounter exposure other biological agent ruled out
  • R05- Cough
  • J20.9- Acute Bronchitis unspecified
  • Z20.822- Contact with and suspected exposure to COVID-19
  • M79.10- Myalgia unspecified site
  • M79.18- Myalgia other site
  • J98.8- Acute Bronchitis due to unspecified organism 
  • Z11.52- Encounter for screening for COVID-19
  • J40- Bronchitis not specified as acute/chronic

UPDATE #3 - DISCONTINUATION OF EVALUATION AND MANAGEMENT LEVELING OF CARE POLICY

AzCH’s payment policy CC.PP.066 was effective for our Marketplace line of business as of August 1, 2020.

AzCH has made a decision to turn off editing related to this policy effective March 12, 2021. AzCH also will not implement this policy for any other lines of business. AzCH will not be completing claims projects to reprocess claims. If you disagree with how a previous claim was processed under the policy, you may request a reconsideration or exercise your appeal/grievance rights and submit medical records for reconsideration.

ADDITIONAL INFORMATION

We encourage you to review our payment policies, provider manuals, and other resources on our website, www.azcompletehealth.com.

    https://www.azcompletehealth.com/providers/preauth-check.html

If you have questions regarding the information contained in this update or need your assigned Provider Engagement Specialist contact information please email: AzCHProviderEngagement@azcompletehealth.com.