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   Providers > Provider Manual


Provider Manual
Please download the following provider manual.

Care1st Provider Manual (AHCCCS, KidsCare, DDD, Healthcare Group)

CARE1ST HEALTH PLAN ARIZONA

PROVIDER MANUAL
TABLE OF CONTENTS

The Care1st Provider Manual is available in PDF format.
Click on the appropriate section title to view the contents.

SECTION I - INTRODUCTION
• Welcome
• Mission Statement
• Introduction to Care1st
• Organization of Care1st

SECTION II - QUICK REFERENCE CONTACT LIST
• Key Departmental Contacts
• Care1st Contracted Vendors
• Arizona Health Care Cost Containment System (AHCCCS)
• Hearing Impaired
• Translation Services

SECTION III - PROVIDER ROLES AND RESPONSIBILITIES
• PCP Gatekeeper Role
• Specialist Responsibility
• PCP Assignment/Provider Enrollment Limit
• Service Delivery Responsibilities
• Appointment and Wait Time Standards
• Provider Network Changes
• Removal of Member from Panel
• Provider Grievances
• Provider Directory
• Member Eligibility Verification
• Follow Up of Cancelled and Missed Appointments
• AHCCCS Cost Sharing Copayments
• Provision of Covered Services
• Receiving Prior Authorization
• Submitting Claims and Encounters
• Use of the Emergency Room
• Documentation
• Data Validation
• Advance Directives
• Non-Discrimination Policy
• Culturally Competent Care
• ASIIS

SECTION IV - MEMBER RIGHTS & RESPONSIBILITIES
• Member Rights
• Member Responsibilities

SECTION V - ELIGIBILITY AND ENROLLMENT
• Eligibility Determination and Enrollment
• KidsCare
• DES/DDD
• Rate Codes
• Member Rosters and Eligibility Verification
• Member Identification Cards
• Newborn Coverage
• Change of Primary Care Physician- Member Initiated

SECTION VI - COVERED SERVICES
• Covered Services
• Chiropractic Services
• Childrens Rehabilitative Services
• Dental Services
• Emergency Services
• EPSDT Services
• Family Planning Extension Services
• Family Planning Services
• Hearing Services
• Laboratory Services
• Maternity Care Services
• Optometry/Vision Services
• Pharmacy Services
• Rehabilitation Services
• Transportation Services

SECTION VII - BEHAVIORAL HEALTH SERVICES
• Overview
• Psychotropic Medication Prescribing/Adjustment/Monitoring
• Behavioral Health Crisis Services
• Behavioral Health Referrals
• Telephonic Consultation Services Through Magellan
• Face-to-Face Consultation Services through Magellan
• Coordination of Care
• Transfer of Care
• Provider Information

SECTION VIII - PROVIDER CLAIM DISPUTES AND APPEALS
• Claim Disputes/Appeals Process

SECTION IX - MEDICAL MANAGEMENT
• Overview of Medical Management
• Prior Authorization and Referral Process
• Case Management
• Concurrent Review
• Retroactive Review
• Pharmacy Management
• Disease Management

SECTION X - QUALITY MANAGEMENT
• Overview
• Confidentiality and Conflict of Interest
• Credentialing
• Peer Review
• Medical Record Guidelines
• Advance Directives

SECTION XI - BILLING, CLAIMS AND ENCOUNTERS
• Required ID Numbers
• Medical Claims Review
• Billing for Services
• Electronic Data Interchange (EDI)
• Electronic Funds Transfer (EFT)

SECTION XII - FRAUD, WASTE AND/OR ABUSE
• Fraud and Abuse
• Deficit Reduction Act

SECTION XIII - HEALTHCARE GROUP
• Healthcare Group Overview
• Member Eligibility
• Other Information

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