Providers are responsible for verifying eligibility each time a member schedules an appointment and when all medical services are provided. The member’s assigned primary care provider (PCP) must also be verified prior to rendering primary care services.
Arizona Complete Health does not reimburse providers for services rendered to members who lost eligibility.
Providers may verify member eligibility through any of the following methodologies:
All Lines of Business
- Arizona Complete Health’s secure provider portal. Providers must be registered and have a password.
- Arizona Complete Health’s telephone verification through the Provider Services Center (to be used as the last resort). To protect member confidentiality, providers are asked for at least three pieces of identifying information, such as member identification number, date of birth and address, before any eligibility information can be released. When calling, use the prompt for the providers.
Arizona Complete Health-Complete Care Plan (Medicaid Only)
The provider must always verify the member’s eligibility and enrollment status, including when a member presents an AHCCCS ID card or a decision letter from an eligibility agency.
Providers may use any one of several verification processes to obtain eligibility, enrollment, and Medicare/TPL information (if available).
- AHCCCS encourages verifications through a batch process (270/271), in which the provider sends a file of individuals to AHCCCS, which AHCCCS returns with information the following day. Information on that process can be obtained by calling the AHCCCS Help Desk at (602) 417-4451.
- AHCCCS has developed a Web application that allows providers to verify eligibility and enrollment using the Internet. Providers also can obtain Medicare/TPL information for a member.
- To create an account and begin using the application, providers must go to https://azweb.statemedicaid.us.
- For technical support when creating an account, providers should call 1-602-417-4451.
- The Medical Electronic Verification System (MEVS) uses a variety of applications to provide member information to providers. For information on MEVS, please contact EMDEON at https://www.changehealthcare.com/contact-us.
- The Interactive Voice Response system (IVR) allows an unlimited number of verifications by entering information on a touch-tone telephone.
Providers may call IVR at:
All others: 1-800-331-5090
- In Maricopa County only, providers can request faxed documentation.
Medifax EDI: 1-800-444-4336
If a provider cannot use the AHCCCS batch or web processes, IVR or EMDEON, for verification of eligibility or enrollment, the provider may call the AHCCCS Verification Unit.
The unit is staffed from 8:00 a.m. to 5:00 p.m., Monday through Friday.
Providers should be prepared to give the operator the following information:
- Provider NPI (if applicable) or the AHCCCS Provider Registration number; and
- Member’s name, date of birth, and AHCCCS ID number or Social Security number; and
- Date(s) of service.