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Provider Type IC, 77, and 05 to Bill Rendering, eff. June 1

Date: 04/12/22

April 12, 2022

IMPORTANT!

Dear Arizona Complete Health-Complete Care Plan (AzCH-CCP), Care1st Providers and Billing Staff:

AHCCCS recently confirmed as of June 1, 2022, the following AHCCCS registered providers must report the individual practitioner who rendered services on professional and dental claims:

  • Integrated Clinics (IC) (Provider Type IC),
  • Behavioral Health Outpatient Clinics (BHOP) (Provider Type 77), and
  • Clinics (Provider Type 05).

For claims with dates of service on and after June 1, 2022, if the individual practitioner who performed the services associated with the clinic visit is not reported, AHCCCS will deny the claim. AHCCCS health plans like AzCH-CCP and Care1st are also required to deny claims if the information is not present.

Exhibit 10-1 (pdf) of the AHCCCS Fee-For-Service Provider Billing Manual provides billing instructions for accurate claims submissions, including examples, and is your best resource.

In addition, if the service is rendered in a school, Place of Service 03, the School ID is required to be submitted. AHCCCS has not yet updated Exhibit 10-1 of the AHCCCS Fee-For-Service Provider Billing Manual to include the school-based requirement but indicated a future update will occur.

Reminders:

  • The rendering provider on the claim is the IC, BHOP or Clinic, not the practitioner. The site-specific NPI and/or the IC, BHOP or Clinic entity name is placed in the following fields of the claim:

Medical Paper Claims

Dental Paper Claims

Medical & Dental EDI Claims

Box 24J and 32

Box 54 and 56

Loop 2310B

  • The participating/performing practitioner information is listed in the following fields of the claim:

Medical Paper Claims

Dental Paper Claims

Medical & Dental EDI Claims

Box 19

Box 35

Loop 2300 NTE segment

  • When submitting a paper claim, populate box 31 on medical and box 53 on dental claims with ‘Signature on file’.

PROVIDER FREQUENTLY ASKED QUESTIONS

Care1st member migration to Arizona Complete Health-Complete Care Plan

 

AzCH-CCP providers and staff:

If you have any questions, please contact your AzCH-CCP Provider Engagement Specialist. If you need your assigned Provider Engagement Specialist’s contact information, please email us at AzCHProviderEngagement@azcompletehealth.com.

Care1st providers and staff:

If you have any questions, please call Provider Network Operations at 602.778.1800 or 866.560.4042 (Options in order: 5, 7) or email SM_AZ_PNO@Care1stAZ.com .