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   Providers > Provider Manual


Provider ManualProvider Manual
Please download the following provider manual.

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

CARE1ST HEALTH PLAN ARIZONA

PROVIDER MANUAL
TABLE OF CONTENTS

Click on the appropriate section title below to view and/or print the contents of a particular section or view the entire manual

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

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

SECTION III - PROVIDER ROLES AND RESPONSIBILITIES
• PCP Gatekeeper Role
• Specialist Responsibility
• Service Delivery Responsibilities
• Care Coordination
• Appointment and Wait Time Standards
• Provider Network Changes
• Removal of Member from Panel
• Provider Inquiries, Complaints, Requests for Information & General Grievances/Disputes
• Provider Directory
• Eligibility Verification
• Cancelled and Missed Appointments
• AHCCCS Cost Sharing & Co-payments
• Provision of Covered Services
• ASIIS
• Referrals and Prior Authorization
• Submitting Claims and Encounters
• Inappropriate Use of the Emergency Room
• Documentation
• Data Validation
• Advance Directives
• Non-Discrimination Policy
• Culturally Competent Care

SECTION IV - MEMBER RIGHTS & RESPONSIBILITIES
• Member Rights
• Member Responsibilities
• Grievances
• Advance Directives

SECTION V - ELIGIBILITY AND ENROLLMENT
• Eligibility Determination and Enrollment
• KidsCare
• DES/DDD
• Rate Codes
• Member Identification Cards
• PCP Assignment
• Eligibility Verification
• Newborn Coverage
• AHCCCS Cost Sharing & Co-Payments

SECTION VI - COVERED SERVICES
• Covered Services
• Chiropractic Services
• Children’s Rehabilitative Services (CRS)
• Dental
• Emergency Services
• EPSDT Services
• Family Planning Extension Services
• Family Planning Services
• Home Health
• Hearing
• Laboratory
• Maternity Care
• Optometry/Vision
• Orthotics and Prosthetics
• Pharmacy
• Podiatry
• Radiology
• Rehabilitation
• Transportation

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 - CLAIM DISPUTES AND APPEALS
• Claim Disputes & Appeals Process
• Member Appeals

SECTION IX - MEDICAL OPERATIONS
•Overview
• Prior Authorization and Referral Process
• Case Management
• Disease Management
• Pharmacy Management
• Concurrent Review
• Retrospective Review

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

SECTION XI - BILLING, CLAIMS AND ENCOUNTERS
• Claim Submissions
• Required ID Numbers
• Billing for Services Rendered
• Medical Claims Review

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

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

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Please note that all materials found on this website are also available in hard copy by contacting Member Services at 602-778-1800 or
1-866-560-4042 or by e-mailing us through the link located in this website.

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