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Member Transition

Background:  In 2020, Arizona Complete Health’s parent company, Centene Corporation, completed the purchase of WellCare, which includes Care1st Health Plan Arizona. As part of this change, approximately 105,000 Care1st Medicaid members in Maricopa, Gila and Pinal counties will become Arizona Complete Health-Complete Care Plan (AzCH-Complete Care Plan) members as of October 1, 2021.




Questions and Answers

There is nothing you need to do. This agreement has been approved by AHCCCS for a 10/1/21 effective date. 

There will be very little impact to you. Nearly all of the providers in the Care1st network are also contracted with AzCH-Complete Care Plan. If you are not part of the AzCH-Complete Care Plan network or are unsure about your status, please reach out to the AzCH-Complete Care Plan Contracting Team via email: azchcontracts@azcompletehealth.com.

This change is taking place only in the Central Geographic Service Area, which is Maricopa, Pinal and Gila Counties.

Care1st will continue to operate in the Northern GSA after 10/1/2021: Mohave, Coconino, Navajo, Apache and Yavapai Counties.

Care1st and AzCH-Complete Care Plan have been working to minimize any impact to Care1st members. Most Care1st members will have access to their same providers. However, some members may need to be assigned to a different PCP or end up transitioning to a different specialist provider.  If a member is assigned to a different PCP or Dental Home, they will be notified in writing in October.

Some differences between the Care1st and AzCH-Complete Care Plan networks include:

  • The Dental Administrator will change from DentaQuest to Envolve Benefit Options (Envolve) Dental Program. Members may continue to see their same dental provider if that provider is also contracted through Envolve Dental’s network. If their current dental provider is not contracted with Envolve, the member may select any in-network dental provider for covered services.
  • Pharmacy benefit claims will continue to process through CVS Health.  Pharmacies may bill claims for AzCH-Complete Care Plan members with BIN: 004336, PCN: MCAIDADV, and Group: RX5443.  The group number is the only change for members coming from Care1st.  The pharmacy network is very similar so most members will continue to get prescriptions filled at their current retail pharmacy. Members utilizing specialty pharmacy medications will be notified in advance if their pharmacy is no longer in the network
  • Non-emergent transportation services. Care1st currently partners with MTBA and AzCH-Complete Care Plan partners with Veyo. However, effective October 1, AzCH-Complete Care Plan will also partner with MTBA and will no longer work with Veyo. Therefore, Care1st members transitioning to AzCH-Complete Care Plan 10/1/21 will have no change in their non-emergent transportation provider.  
  • Routine vision services will transition to Envolve Benefit Options (Envolve) Vision Program. Members will continue to see their same vision provider if that provider is contracted with Envolve Vision’s network. If their current vision provider is not contracted with Envolve, they may select any in-network vision provider for covered services.

This is seamless for members. Members did not have to do anything to effectuate this change. All impacted members had the opportunity to choose a different AHCCCS plan during a special choice period in July. Care1st members that did not choose another plan during the special choice period will automatically become AzCH-Complete Care Plan members effective 10/1/21. Approximately 105,000 Care1st members will become AzCH-Complete Care Plan members.

No. All AHCCCS health plans provide the same covered services to its members as required by law and contract.

Yes, Care1st members will receive an ID card from their new plan within 12 business days of October 1st. An example of the AzCH-Complete Care Plan ID card is below. Although the PCP name is not listed on our ID card, the member receives confirmation of their assigned PCP via a letter that accompanies the card. An example can be seen here: AzCH-Complete Care Plan ID.
 

Claims

You should submit claims for services rendered prior to 10/1/21 to Care1st. Claims for services rendered on or after 10/1/21 for AzCH-Complete Care Plan members should be submitted to AzCH-Complete Care Plan. AzCH-Complete Care Plan encourages you to submit claims electronically through Availity.  Our payer ID is 68069.

Paper Claims may be mailed to:

            Arizona Complete Health-Complete Care Plan
            PO Box 9010
            Farmington, MO 63640

Additional details on claims submission included in our separate Billing Communication (1st distribution date = end of August)

Prior Authorizations

The AzCH-Complete Care Plan Pre-Auth Check tool is available on our website under the Provider section.

Please use this tool to determine if PA is required. You can submit PA requests online via our secure Provider Portal or by fax.

No. Care1st will share all open (unused) PAs with AzCH-Complete Care Plan. AzCH-Complete Care Plan will honor these PAs through the expiration date or 11/30/21, whichever comes first.

Although the AzCH-Complete Care Plan PA Team is responsible for the majority of PAs, AzCH-Complete Care Plan works with outside partners for review of PA for certain services.  Those partners, listed

  • Chiropractic Services: ASH.  ASH will honor open PAs through the expiration date or 11/30/21, whichever comes first.
  • Complex imaging, MRA, MRI, PET, and CT: NIA. NIA will honor open PAs through the expiration date or 11/30/21, whichever comes first. 
    • Website: RadMD 
    • Phone Number: (800) 327-0641.
  • Dental Services: Envolve Dental. Envolve Dental will honor open PAs through the expiration date or 11/30/21, whichever comes first. 
  • Orthopedic Procedures: Turning Point. Although Turning Point reviews requests, the PAs are then entered into the AzCH-Complete Care Plan system for claims payment.  Open Care1st PAs for these service will be honored through the expiration date or 11/30/21, whichever comes first 
  • Oncology/Supportive Drugs: New Century. New Century will honor open PAs through the expiration date or 11/30/21, whichever comes first.
  • Vision Services: Envolve Vision. Care1st does not require PA for vision service.  Envolve Vision is responsible for preventive services screenings and hardware. No PA is required for par providers 

If you are not a participating (non-par) provider with AzCH-Complete Care Plan, like all non-par providers, a PA is required for all services. You may submit a PA request via fax or register for our secure portal and submit the request electronically through the portal.

If you are a participating (par) provider with AzCH-Complete Care Plan, you should determine if a PA is needed before providing the service by using our PA Look Up Tool. If a PA is needed, you may submit a request via the secure web portal or fax.

Our Medical Management Team is reviewing these members closely and if there is a PA that will be extended into December 2021, they will enter a PA, you will receive written notification of that PA and it will include a 12/1/21 effective date. 

OB care and deliveries authorized by Care1st that occur between 10/1/21-11/30/21 will be honored by AzCH-Complete Care Plan. Care1st is also sharing with AzCH-Complete Care Plan those members they are aware of with delivery dates between 12/1/21-12/31/21. AzCH-Complete Care Plan Medical Management will enter a PA for 12/1/21-12/31/21 deliveries after the face sheet is submitted and you will receive written notification of the PA. For OB care and deliveries after 12/31/2021 please follow the normal AzCH-Complete Care Plan notification process.

No. Care1st will share open pharmacy benefit PAs with AzCH-Complete Care Plan. AzCH-Complete Care Plan will honor the open pharmacy prior authorizations through the expiration day or 9/30/2022, whichever comes first. In office injectable drug PA requests will need to be submitted before the expiration date or 11/30/21, whichever comes first.

If you are not in the AzCH-Complete Care Plan network, you may request a PA for continuity of care.  Your request will follow the out of network review process and you will be notified if the service request is approved or denied. Please use the Medicaid AzCH-Complete Care Plan PA Form. You may also contact the Provider Call Center for a hard copy of these documents.  Please provide all pertinent clinical information including current treatment plan with your request.

AzCH-Complete Care Plan serves traditional Medicaid, CHIP members and Medicare Dual SNP members in Maricopa, Pinal, Gila, Cochise, Graham, Greenlee, La Paz, Pima, Santa Cruz, and Yuma counties. Care1st members transitioning to AzCH-Complete Care Plan who also have Medicare coverage have the option of enrolling in Wellcare by Allwell, Arizona Complete Health’s Medicare offering, to be in an aligned plan.   Members who want to enroll in Wellcare by Allwell may contact the Medicare Sales Center at (866) 850-7255.

Provider Questions and Feedback

If you have any additional questions or feedback regarding the Provider FAQs fill out the below fields and the our Provider Communications team will reach back out to you.

Provider Resources

Request Type

Instructions

  • New contract
  • Visit our Become a Provider page for more information regarding joining our network.  All directions and necessary documents are found on this site.
  • If you think you are already contracted, please send an email to AzCHpotentialprovider@azcompletehealth.com and request verification of your contract status.

Status of a pending contract or questions regarding an existing contract

Add Practitioner to an existing contract

AzCH-Complete Care Plan Medicaid PA Form

Provider Portal Access Request

Status Requests for provider/practitioner updates (e.g. adds, terms, changes)

  • Submit to: AzCHproviderdata@azcompletehealth.com
  • Or fax to 866-687-0514.
  • Please include the following:
    • Group full name
    • Organizational NPI
    • TIN
    • Practitioner full name and NPI (when applicable)
    • Detailed explanation of your request

Dental provider updates

Questions regarding claims or other provider issues

Other general questions

  • AZ Member Call Center 888-788-4408
  • AZ Provider Call Center 866-796-0542
  • Use Contact Us form on website (for all inquiry types)