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ARIZONA HOUSE OF REPRESENTATIVES57th Legislature, 2nd Regular Session |
Senate: HHS DP 4-3-0-0 | Third Read 16-10-4-0 |
SB 1346: AHCCCS; fee-for-service; claims
Sponsor: Senator Werner, LD 4
Committee on Health & Human Services
Overview
Directs the Arizona Health Care Cost Containment System (AHCCCS) Division of Fee-For-Service Management (DFSM) to notify a person or entity of any administrative deficiencies in a claim within 72 hours and approve or deny the claim within 10 days if the deficiencies are corrected or there are no deficiencies.
History
Established in 1981, AHCCCS is Arizona's Medicaid program that oversees contracted health plans for the delivery of health care to individuals and families who qualify for Medicaid and other medical assistance programs. Through contracted health plans across the state, AHCCCS delivers health care to qualifying individuals including low-income adults, their children or people with certain disabilities. Members must meet certain financial and nonfinancial requirements to be eligible for AHCCCS (A.R.S. § 36-2901).
DFSM is a division of AHCCCS that functions as the health plan for Medicaid members receiving services through the fee-for-service system and processes claims for certain populations who are not enrolled with a contractor. DFSM oversees the clinical, administrative, and claims operations for approximately 12 percent of AHCCCS members under fee-for-service management, including: 1) American Indians and Alaska Natives enrolled in the American Indian Health Program for specified services; 2) members receiving behavioral health care coordination through tribal regional behavioral health authorities; 3) members enrolled in tribal long-term care programs; and 4) individuals participating in the Federal Emergency Services program (AHCCCS).
Fee-for-service is a method of payment by AHCCCS to a registered provider on an amount-per-service basis for a member not enrolled with a contractor (A.A.C. R9-22-101).
Provisions
1. Requires DFSM to notify the person or entity that submitted a claim of all administrative deficiencies in the claim, if any, within 72 hours after receiving the claim. (Sec. 1)
2. Requires AHCCCS to either approve or deny the claim within 10 business days if:
a. the person or entity corrects all administrative deficiencies in the claim; or
b. there were no administrative deficiencies in the claim. (Sec. 1)
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f. Initials AG/LK SB 1346
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