22-102 Medicaid Prior Authorization and Concurrent Review Updates Effective October 1, 2022
Date: 08/31/22
Dear AZ Complete Health-Complete Care Plan (AzCH-CCP) & Care1st Arizona Providers & Staff:
AHCCCS published a memo on August 1, 2022 (PDF) available on the AHCCCS website. It outlines that effective October 1, 2022, AHCCCS will begin to allow some of the prior authorization and concurrent review activities eased during the COVID-19 pandemic to restart. Below we call out key changes that AzCH-CCP and Care1st will make effective October 1, 2022.
Behavioral Health Services
Concurrent review and related activities will resume at a frequency of every 30 days for Inpatient Residential Treatment Centers (RTCs) in instances where MCOs have opted to extend the timeframe beyond the 30-day standard. Since AzCH-CCP and Care1st have continued to do 30-day reviews there is no change.
Physical Health Services
Concurrent Review
Effective for admissions October 1, 2022 and forward, we will return to our Pre-COVID standard concurrent
review processes, regardless of the member’s reason for admission/observation status. AzCH-CCP and Care1st require notification of all admissions. All admissions will be concurrently reviewed to evaluate the medical necessity of the admission, monitor the appropriateness of the services provided to a member during an inpatient stay, assist with discharge planning for coordination of care, and to assign the appropriate lower level of care or alternate hospital setting for clinical needs requiring PA transfers for SNF, INR, and LTAC.
Post-Acute Services
Effective for admissions October 1, 2022 and forward, we will return to our Pre-COVID standard prior authorization practices for post-acute services including inpatient rehabilitation, long term acute care, assisted living, and skilled nursing facility admissions. AzCH-CCP and Care1st require prior authorization for post-acute services.
Outpatient Services
Effective for dates of services October 1, 2022 and forward, we will return to our Pre-COVID standard prior authorization practices for outpatient services. For AzCH-CCP prior authorization information visit our website at www.azcompletehealth.com > For Providers > Pre-Auth Check > Medicaid Pre-Auth. For Care1st Prior Authorization information visit our website www.care1staz.com > Care1st > Providers > Prior Authorization Guidelines & Criteria.
AzCH providers and staff:
If you have any questions, please contact your AzCH 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 1-866-560-4042 (Options in order: 5, 7) or email SM_AZ_PNO@care1staz.com.
THANK YOU!