Providers

Provider Manual

Provider Manual
Chapter 1 Introduction to ACA StandardHealth with Health Choice
Exhibit 1-1 Provider Escalation Notice
Chapter 2 Member Eligibility and Member Services
2024 ACA StndHlth_w_HC_On Base Benefit Book
2024 ACA StndHlth_w_HC_Off Base Benefit Book
Plan Documents 2024 | AZBlue | Summary of Benefits
Chapter 3 Provider Responsibility
Chapter 4 Cultural Competency
Chapter 5 Quality Management
Exhibit 5.1 Care Management Referral Form
Chapter 6 Authorizations and Notifications
Exhibit 6.2 Medical Services and Behavioral Health Prior Authorization Form
PA and Continued Stay Review Form for Psychiatric Hospitals and Sub-Acute Facilities
BHIF, BHRF, TFC, and SUD BHRF Prior Authorization and Continued Stay Request Form
Notification of Admission, Transfer and Discharge for Out of Home Placements
Chapter 7 General Billing Rules
Chapter 8 Billing on the CMS 1500 Claim Form
Chapter 9 Billing on the UB Claim Form
Chapter 10 Billing on the ADA Claim Form
Chapter 11 Claims Processing
Chapter 12 Correcting Claim Errors
Chapter 13 Understanding the Remittance Advice
Exhibit 13.1 Medical Remittance Advice
Exhibit 13.2 Dental Remittance Advice
Exhibit 13.3 Remittance Denial Codes
Chapter 14 Medicare and Other Insurance Liability
Chapter 15 Claim Disputes, Member Appeals, and Member Grievances
Chapter 16 Maternal Health and Children’s Services
Exhibit 16.4 Newborn Reporting Form
Exhibit 16.10 Maternal Risk Assessment
Chapter 17 Pharmacy and Drug Formulary
Prescription Medication Formulary
Chapter 18 Hospital Services
PA and Continued Stay Review Form for Psychiatric Hospitals and Sub-Acute Facilities
BHIF, BHRF, TFC Prior Authorization and Continued Stay Request Form
Notification of Admission, Transfer and Discharge for Out of Home Placements
Northern AZ ED Reporting
Chapter 19 Oral Health Services
Exhibit 19.1 Dental Specialty Request form
Chapter 20 Care Management
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