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Provider News
2022
12/09/2022 - AHCCCS E.V.V. Electronic Visit VerificationPlease review this entire communication for up-to-date information on Electronic Visit Verification (EVV) requirements and guidance. 12/01/2022 - Ultrasound Multiple Procedure Payment Policy Effective 1/1/23
Effective 01/01/23 the policy regarding non-obstetrical and obstetrical transabdominal and transvaginal ultrasounds, as outlined below, will be implemented. 11/29/2022 - PROVIDER FORUM NOTIFICATION & INVITATION
You are invited to join Care1st as we present the RBHA Post Go-Live Implementation & 12/1/22 System Integration Provider Forum 11/21/2022 - 10/1/22 RBHA Implementation & 12/1/22 ACC System Migration What You Need to Know! Vol 4
This is a follow up to our 9/26/22 communication. Care1st currently administers physical and behavioral health services to approximately 85,000 AHCCCS Complete Care (ACC) members in the Northern Geographic Services Area (GSA). The Northern GSA includes Mohave, Coconino, Navajo, Apache, and Yavapai Counties. 11/17/2022 - 2022-2023RSV SEASON- Synagis®
Care1st has been closely monitoring Respiratory Syncytial Virus (RSV) activity in Arizona and acknowledges we are experiencing an unprecedented RSV Season. 11/01/2022 - Care1st Network Management Fax Number Change & Provider Manual Updates
Effective 12/01/2022, the fax number for Care1st Network Management will change. The Care1st Provider Manual has been updated (October 2022 revision date) and is available on our website 10/04/2022 - AHCCCS E.V.V - Electronic Visit Verification
Providers, please read this entire communication for the most up-to-date information on Electronic Visit Verification (EVV) requirements and guidance. 09/29/2022 - PROVIDER MANUAL UPDATES
The Care1st Provider Manual has been updated (September 2022 revision date) and is available on our website 09/28/2022 - Care1st is pleased to announce its collaboration with New Century Health (NCH), an oncology quality management company
Effective December 1, 2022, we will implement a new oncology pre-approval program, Care1st Oncology Pathway Solutions, for Medicaid members. 09/26/2022 - 10/1/22 RBHA Implementation & 12/1/22 ACC System Migration What You Need to Know! Vol 3
Effective 10/1/22, we will begin serving as the Regional Behavioral Health Authority (RBHA) in the Northern GSA. We’ll onboard approximately 6,000 AHCCCS RBHA members in the Northern GSA. 09/12/2022 - PROVIDER FORUM NOTIFICATION & INVITATION
You are invited to join Care1st as we present the Fall 2022 Provider Forums, 9/15 or 9/22 09/09/2022 - 10/1/22 RBHA Implementation & 12/1/22 ACC System Migration What You Need to Know! Vol 2
We have changes underway we want to share with you. This is a follow up from our 8/17/22 communication. The pages below outline specifics and timelines 09/01/2022 - PROVIDER MANUAL UPDATES
The Care1st Provider Manual has been updated (April 2021 revision date) and is available on our website 08/31/2022 - Medicaid Prior Authorization and Concurrent Review Updates Effective October 1, 2022
Effective October 1, 2022, AHCCCS will begin to allow some of the prior authorization and concurrent review activities eased during the COVID-19 pandemic to restart. Below we call out key changes that AzCH-CCP and Care1st will make effective October 1, 2022. 08/29/2022 - FORMULARY UPDATES - Effective 10/01/2022
Effective October 1, 2022, Care1st will implement the AHCCCS formulary changes based on the recommendations from the May 24, 2022, AHCCCS Pharmacy & Therapeutics (P & T) Committee. AHCCCS Formulary changes are located on our website 08/17/2022 - 10/1/22 RBHA Implementation & 12/1/22 ACC System Migration - What You Need to Know!
We have changes underway that we want to share with you. We will communicate these changes multiple times prior to the effective date. 08/15/2022 - Arizona Complete Health and Care1st Health Plan Arizona Address Change Effective 9/30/2022
Arizona Complete Health and Care1st Health Plan Arizona Address Change Effective 9/30/2022 08/02/2022 - PEER-TO-PEER REVIEW REQUEST REQUIREMENTS FOR WELLCARE PPO PLAN EFFECTIVE 9/1/2022
To ensure accurate delivery and reimbursement for medically necessary services to our members, Wellcare is updating our requirements for peer-to-peer review to the following effective 9/1/2022 08/02/2022 - PROVIDER FORUM NOTIFICATION & INVITATION
You are invited to join Care1st as we present the Fall 2022 Provider Forum. 07/29/2022 - Care1st Regional Behavioral Health Authority (RBHA) Implementation Effective 10/1/2022
In addition to serving the AHCCCS Complete Care (ACC) population, Care1st will begin serving as the RBHA in the Northern geographical service area (GSA) starting on 10/1/2022 06/27/2022 - FORMULARY UPDATES Effective 08/01/2022 & Billers Corner
Effective August 1, 2022, Care1st will implement the AHCCCS formulary changes based on the recommendations from the May 24, 2022, AHCCCS Pharmacy & Therapeutics (P & T) Committee. 06/23/2022 - BHRF Services: Use of Augmentative and Alternative Communication (AAC) devices
To ensure members with disabilities are provided with the necessary equipment to communicate their needs, AHCCCS registered behavioral health residential facilities (BHRF) shall comply with Title II and III of the Americans with Disabilities Act. 06/07/2022 - EPSDT SERVICES: EYEGLASS REPLACEMENTS AND REPAIRS CLARIFICATION
There are no restrictions or limitations for EPSDT members for replacement and repair of eyeglasses, when medically necessary for vision correction. 06/03/2022 - IMPORTANT! Integrated Clinics, Behavioral Health Outpatient Clinics & Clinics Must Bill Rendering Practitioner on Medicaid Claims Beginning October 1, 2022
In April we notified you that as of June 1, 2022, the AHCCCS registeredproviders bulleted below must begin to report the individual practitioner who rendered services on professional and dental claims. Since our initial communication, many of you contacted AHCCCS and asked for more time to implement this change. AHCCCS heard your concerns and confirmed for us they moved the go live date from June to October 1, 2022. 06/01/2022 - Medicare Prior Authorization Changes Effective 7/1/22
Our Medicare team recently completed a review ofthe codes listed on the following pages. These updates are applicable to Wellcare PPO Medicare and are effective July 1, 2022. 05/23/2022 - Helping you care for your patients is our top priority
Strong communication and trust between you and your patients will help ensure they‘re satisfied and have good outcomes. You can rely on Care1st Health Plan Arizona for information and support to help you keep those patient relationships strong. 04/28/2022 - EPSDT SERVICES: EYEGLASS REPLACEMENTS AND REPAIRS CLARIFICATION
The Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program provides comprehensive health care services through primary prevention, early intervention, diagnosis, and medically necessary treatment to correct or ameliorate defects and physical or mental illnesses discovered by the screenings for persons under the age of 21 years. 03/22/2022 - Behavioral Health Clinical Chart Audit
The Arizona Medicaid Contractors/Health Plans have aligned efforts under the Arizona Association of Health Plans (AzAHP) to conduct Behavioral Health Clinical Chart Audits (BHCCA). 03/21/2022 - REMINDER: PROVIDER FORUM NOTIFICATION & INVITATION - 3/31/2022
You are invited to join Care1st as we present the Spring 2022 Provider Forum. The Forum will be held on Thursday March 31 at 10:00AM 03/18/2022 - BEHAVIORAL HEALTH UPDATE Effective 03/21/2022
Care1st has been authorizing an additional 10 days upon denial of services for members already in placement. Care1st will discontinue this practice beginning March 21, 2022. 03/16/2022 - NEW WOUND VAC PROVIDER
Care1st and Wellcare (PPO) partner with Sisu Healthcare Solutions to provide negative pressure wound therapy (Wound Vac) services. 03/03/2022 - Billers' Corner Top 5 Professional Claims Encounter Errors/ New Edits for 3/1/2022
When Care1st processes your claim, the encounter is sent to AHCCCS for acceptance. If AHCCCS finds errors, the encounter is returned... 03/03/2022 - PROVIDER FORUM NOTIFICATION & INVITATION - 3/31/2022
You are invited to join Care1st as we present the Spring 2022 Provider Forum. The Forum will be held on Thursday March 31 at 10:00AM 03/02/2022 - Invitation to Respond: Crisis Line
Care1st sent out a notice on 2/18/2022 regarding an Invitation to Respond − Crisis Line. 02/23/2022 - FORMULARY UPDATES Effective 04/01/2022
Effective April 1, 2022, Care1st will implement the AHCCCS formulary changes based on the recommendations from the January 19, 2022, AHCCCS Pharmacy & Therapeutics (P & T) Committee. 02/22/2022 - Differential Adjusted Payment (DAP) opportunity for providers
AHCCCS intends to offer a Differential Adjusted Payment (DAP) opportunity for providers who send their employment staff, or other staff that provide employment services, to an ACRE-approved (Association of Community Rehabilitation Educators) Job Developer training and receive the Certificate of Achievement. 02/18/2022 - REFERRING, ORDERING, PRESCRIBING, ATTENDING (ROPA) UPDATE
The Patient Protection and Affordable Care Act (ACA) and the 21st Century Cures Act (Cures) require that all health care providers who refer AHCCCS members for an item or service, who order non-physician services for members, who prescribe medications to members, and who attend/certify medical necessity for services and/or who take primary responsibility for members' medical care must be registered as AHCCCS providers. AHCCCS calls this initiative, and these providers, "ROPA". 02/18/2022 - Invitation to Respond: Crisis Line
Mercy Care, Care1st Health Plan (Care1st) and Arizona Complete Health-Complete Care Plan (AzCH-Complete Care Plan) are seeking to contract with a strategic partner to provide statewide crisis phone services to people in Arizona. 02/15/2022 - NATIONAL IMAGING ASSOCIATES (NIA) ELIGIBILITY ISSUE
Late last week, NIA notified us of an issue related to loading of eligibility. This issue is causing some prior authorizations to be denied for member eligibility when the member is active and enrolled. 01/26/2022 - Billers Corner Wellcare by Allwell D-SNP – Care1st Dual-Eligible Member Claims
A new year lies before us with lots of opportunities as well as potential pitfalls that can cause delays or denials in claim payments. 01/18/2022 - Prepare for DAP CYE 2023
As a healthcare provider in Arizona, you can receive a higher reimbursement rate through the AHCCCS Differential Adjusted Payment (DAP) program when you join and receive patient information from the Arizona health information exchange (HIE). 01/14/2022 - Billers Corner 11/2021 & 12/2021
Billers Corner 11/2021 & 12/2021
2021
12/22/2021 - Wellcare Medicare Claim Submission & Cross Over Changes Effective for Dates of Service January 1, 2022 and Forward
Effective for dates of service 1/1/22 and forward, the former Care1st Medicare plans, i.e., WellCare Value, Compass and Dividend (HMO) and WellCare Liberty (DSNP) are transitioning to Wellcare by Allwell Medicare plans administered by Arizona Complete Health on the Arizona Complete Health claim platform.
Effective January 1, 2022, Care1st will implement the AHCCCS formulary changes based on the recommendations from the October 18, 2021 AHCCCS Pharmacy & Therapeutics (P & T) Committee. 11/01/2021 - Billers' Corner - Migration of Central Members and NIA Authorizations Reminders - October 2021
As a reminder, the Care1st members residing in Maricopa, Gila, and Pinal counties migrated from Care1st to the AzCH Complete Care Plan effective 10/01/21. 09/30/2021 - Follow Up After Hospitalization for Mental Illness (FUH) – 7 Days
What is Measured - The percentage of discharges for members 6 years of age and older who were hospitalized for treatment of mental illness or intentional self-harm diagnoses and who had a follow-up visit with a mental health provider. 09/30/2021 - SKIN SUBSTITUTE PRIOR AUTHORIZATION UPDATES Effective November 1, 2021
Effective November 1, 2021, Care1st is updating the skin substitute prior authorization (PA) requirements to align with the AHCCCS preferred products 09/29/2021 - 2021-2022 RSV SEASON - Synagis
Care1st has been closely monitoring Respiratory Syncytial Virus (RSV) activity in Arizona and has taken the necessary steps to ensure patients who are at high risk for RSV infection can continue to receive appropriate care. 09/16/2021 - PROVIDER FORUM NOTIFICATION & INVITATION - September 28,2021
You are invited to join Care1st as we present the Fall 2021 Provider Forum. The Forum starts at 10:00AM on September 28, 2021 09/15/2021 - PROVIDER FREQUENTLY ASKED QUESTIONS II - UPDATED Care1st Member Migration to Arizona Complete Health-Complete Care Plan
In 2020, Arizona Complete Health's parent company, Centene Corporation, completed the purchase of WellCare, which includes Care1st Health Plan Arizona. As part of this change, approximately 105,000 Care1st Medicaid members in Maricopa, Gila and Pinal counties will become Arizona Complete Health-Complete Care Plan (AzCH-Complete Care Plan) members as of October 1, 2021. 08/01/2021 - Billers' Corner - Bilateral Billing / Pathology Claims - August 2021
We have two topics we wanted to discuss with you today, based on an increase in denials that have been going out. As always, our goal is to help you get your claim paid correctly the first time and to avoid resubmissions. 07/01/2021 - Billers' Corner - WellCare Liberty Dual Eligible Member Claims - July 2021
When a member is WellCare Liberty Dual Eligible, multiple claim submissions can create a big problem. 08/31/2021 - FORMULARY UPDATES - Effective 10/1/2021
Effective October 1, 2021, Care1st will implement the AHCCCS formulary changes based on the recommendations from the May 19, 2021 AHCCS Pharmacy & Therapeutics (P&T) Committee 08/30/2021 - PROVIDER FORUM NOTIFICATION & INVITATION - September 28, 2021
You are invited to join Care1st as we present the Fall 2021 Provider Forum - RSVP by September 21,2021 - Forum on September 28,2021 08/06/2021 - PROVIDER FREQUENTLY ASKED QUESTIONS Care1st Member Migration to Arizona Complete Health-Complete Care Plan
Background: In 2020, Arizona Complete Health's parent company, Centene Corporation, completed the purchase of WellCare, which includes Care1st Health Plan Arizona. 08/06/2021 - AHCCCS Minimum Subcontract Provision Updates Effective October 1, 2021
Effective October 1, 2021, the AHCCCS Minimum Subcontract Provisions, Section 15 Fraud and Waste is updated to reflect the following language. The AHCCCS Minimum Subcontract Provisions are referenced and incorporated into your Care1st Agreement as required by AHCCCS. 07/02/2021 - COVID-19 Vaccination Campaign
Thank you for your partnership with WellCare Health Plans. As we continue to navigate the COVID-19 pandemic we have been working to ensure that our members have the support they need in their efforts to get vaccinated. 07/01/2021 - Prior Authorization Flexibilities in Response to Avastin Shortage
Care1st Health Plan Arizona is aware of the current shortage of repackaged Avastin and the impact it has on your practice and your ability to care for your patients and our members. 06/29/2021 - Care1st Members Transition to Arizona Complete Health Effective October 1, 2021
In January 2020, WellCare, parent company of Care1st, and Centene, parent company of Arizona Complete Health (AzCH) merged. 06/24/2021 - FORMULARY UPDATES - Effective 8/1/2021
Effective August 1, 2021, Care1st will implement the AHCCCS formulary changes based on the recommendations from the May 19, 2021 AHCCS Pharmacy & Therapeutics (P & T) Committee. 05/28/2021 - Reinstatement of Prior Authorization Requirements for COVID Treatment and Telehealth Services
WellCare Health Plans is updating its prior authorization (PA) requirements for COVID treatment and Telehealth services for Medicare. 05/06/2021 - PROVIDER MANUAL UPDATES
The Care1st Provider Manual has been updated (April 2021 revision date) and is available on our website: 04/19/2021 - AHCCCS 2021 Provider Survey
AHCCCS is conducting a survey to determine its contracted Managed Care Organizations’ (MCOs’) performance and responsiveness to providers. 03/22/2021 - Billers' Corner - COVID-19 Billing - March 2021
The Emergency Declaration related to the COVID-19 pandemic continues to impact all of us. Below are a few resources on billing to reduce denials and get your claim paid on the initial submission. 03/22/2021 - Care1st Members Transition to Arizona Complete Health Effective October 1, 2021
In January 2020, WellCare, parent company of Care1st, and Centene, parent company of Arizona Complete Health (AzCH) merged. Currently, both Care1st and AzCH service the AHCCCS Central Geographical Service Area (GSA), which includes Gila, Maricopa and Pinal counties. Effective October 1, 2021, Care1st will no longer service the Central GSA. 03/16/2021 - AHCCCS Bed Capacity Survey - Behavioral Health Residential Facilities and Residential Treatment Centers
AHCCCS in partnership with its contracted health plans, has developed a survey for providers who manage Behavioral Health Residential Facilities (BHRFs) and Residential Treatment Centers (RTCs). 03/10/2021 - REMINDER - PROVIDER FORUM NOTIFICATION & INVITATION - Spring 2021
REMINDER - PROVIDER FORUM NOTIFICATION & INVITATION - Spring 2021
You are invited to join Care1st as we present the Spring 2021 Provider Forum. The Forum starts at 10:00AM March 30, 2021 03/04/2021 - FORMULARY UPDATES Effective 4/1/2021
Effective April 1, 2021, Care1st will implement the AHCCCS formulary changes based on the recommendations from the January 26, 2021 AHCCS Pharmacy & Therapeutics (P & T) Committee. 03/03/2021 - PROVIDER FORUM NOTIFICATION & INVITATION - Spring 2021
You are invited to join Care1st as we present the Spring 2021 Provider Forum. The Forum starts at 10:00AM March 30, 2021 02/24/2021 - AHCCCS Bed Capacity Survey
AHCCCS in partnership with its contracted health plans, has developed a survey for providers who manage Behavioral Health Residential Facilities (BHRFs) and Residential Treatment Centers (RTCs) 02/12/2021 - Billers' Corner - Non-Emergency Transportation Claim Billing Reminders
We have recently seen an influx of incorrectly billed claims for non-emergency transportation. Below are some reminders on billing for these services to prevent denials on the initial submission. 02/12/2021 - Outpatient Imaging Program Provider Education Webinars
In an effort to continue promotion of quality improvement for services provided to Care1st Health Plan Arizona (Care1st) and WellCare of Arizona (WellCare) members, effective March 1, 2021, Care1st and WellCare will use National Imaging Associates, Inc. (NIA) to provide the management and prior authorization of non-emergent, advanced, outpatient imaging services. 01/30/2021 - UPDATES TO PRIOR AUTHORIZATION GUIDELINES FOR IMAGING PROCEDURES Effective March 1, 2021
In keeping with our commitment of promoting continuous quality improvement for services provided to Care1st Health Plan Arizona (Care1st) and WellCare members, Care1st and WellCare has entered into an agreement with National Imaging Associates, Inc. (NIA)1, to implement a radiology benefit management program. This program includes management of non-emergent, advanced, outpatient imaging services to include prior authorization for Care1st‘s Medicaid and WellCare‘s Medicare members. 01/19/2021 - Connect to the AZHIE - Improve Care
Imagine more complete data for your organization. 01/06/2021 - AHCCCS Electronic Visit Verification (EVV) FAQs & Timeline
AHCCCS FAQs are available to assist with questions about EVV. The following FAQs are posted on the AHCCCS EVV website:
- Member and Provider Focused Device FAQs
- Telehealth and EVV FAQs
2020
12/30/2020 - Billers' Corner - Maternity Service Claims
As we continue to focus on identifying ways to improve our customer service, to get
your initial claims processed and to reduce duplicate billing, Care1st has implemented
the following changes to streamline the handling of maternity service claims.
Providers have been crucial in the fight against COVID-19. We want to be prepared and engage our partners now, so we are ready when vaccines are available for distribution in Arizona. 11/30/2020 - FORMULARY UPDATES Effective 1/1/2021
Effective January 1, 2021, Care1st will implement the AHCCCS formulary changes based on the recommendations from the October 14, 2020 AHCCCS Pharmacy & Therapeutics (P & T) Committee. 11/20/2020 - AHCCCS RATE UPDATE OCTOBER 1, 2020
Laws 2020, Ch. 46, Sec. 2 requires AHCCCS to increase base reimbursement rates for services reimbursed under the administration‘s dental fee schedule and physician fee schedule 11/18/2020 - Billers' Corner - Modifier Usage and Record Requirements
Our goal is to assist you in getting your claims paid on your initial submission. When applicable, the appropriate modifiers must be billed for claims payment. 11/11/2020 - Be Vaccine-Ready!
Providers have been crucial in the fight against COVID-19. We want to be prepared and engage our partners now, so we are ready when vaccines are available* for distribution in Arizona. 11/11/2020 - Pandemic Vaccine Provider Onboarding Tool
Click the onboarding link - Pandemic Vaccine Provider Onboard Form 1 and fill out the form 11/06/2020 - News from Immunization Program Office
Today's topic: Pandemic Provider Onboarding 11/03/2020 - Free PPE - Deadline November 4, 2020
In partnership with the Maricopa County Department of Health, the Arizona Medical Association (ArMA) is pleased to offer FREE PPE to any physician who needs it throughout the state. We will be distributing NIOSH N95 masks, 3-ply disposable masks, and Nitrile gloves, free of charge. 10/23/2020 - CR MODIFIER REMINDERS: COVID-19 TESTING & TREATMENT
As a reminder, services billed for COVID-19 testing or related services shall be billed according to guidance outlined in the AHCCCS COVID-19 FAQs to ensure accurate reporting 10/20/2020 - REMINDER:Our Physical Address Has Changed as of October 1, 2020
All Necessary Addresses are listed in the attached document 10/19/2020 - 2020-2021 RSV SEASON - Synagis®
As RSV season approaches, it is important to make arrangements to ensure that pediatric members who may be at risk for RSV receive Synagis® to prevent RSV infection. 09/18/2020 - PROVIDER FORUM NOTIFICATION & INVITATION - Update
You are invited to join Care1st as we present the Fall 2020 Provider Forum. - 09/29/2020 09/17/2020 - PROVIDER FORUM NOTIFICATION & INVITATION
You are invited to join Care1st as we present the Fall 2020 Provider Forum. - 09/29/2020 09/16/2020 - Reminder: AHCCCS IAD Reporting is Mandatory!
We want to take this opportunity to remind all BH providers of the expectation to report all Incidents, Accidents and Deaths (IAD) through the IAD Database (Portal). 09/15/2020 - LATINOS CONTRA EL CÁNCER - HEALTH & WELLNESS FAIR 2020
Health & Wellness Fair 2020 - 9/22/2020 - Zoom or Facebook Live 09/15/2020 - REMINDER: Care1st/WellCare Physical Address Change Effective 10/01/2020
Our Address is changing effective 10/01/2020 to: 1870 W Rio Salado Parkway Tempe, AZ 85281 09/04/2020 - 2020-21 Flu Season Recommendations Amid COVID-19
The CDC's Advisory Committee on Immunization Practices shared updated influenza vaccine recommendations for the 2020-21 season in late August, recommending that health care providers offer flu shots to everyone 6 months and older with no contraindications by the end of October. 09/02/2020 - PROVIDER FORUM NOTIFICATION & INVITATION - September 29, 2020
You are invited to join Care1st as we present the Fall 2020 Provider Forum. 09/01/2020 - AHCCCS Update: Minimum Subcontract Provisions
AHCCCS made a number of updates to the Minimum Subcontract Provisions effective October 1, 2020. 08/31/2020 - FORMULARY UPDATES Effective 10/01/2020
As a reminder, In accordance with national standards and AHCCCS guidelines, Care1st requires the original claim number on all corrected claims, resubmissions and voids in order to prevent duplicate or timely filing denials. 08/31/2020 - Care1st/WellCare Physical Address Change Effective 10/01/2020
Our Address is changing effective 10/01/2020 08/20/2020 - FORMULARY UPDATES Effective 10/01/2020
Effective October 1, 2020 Care1st will be implementing the AHCCCS formulary changes based on the recommendations from the May 19th, 2020 AHCCCS Pharmacy & Therapeutics (P & T) Committee. 08/18/2020 - Increasing Colorectal Cancer Screening Amidst COVID-19: FluFIT Program Implementation and Best Practices
This live webinar presentation will include a brief discussion of the epidemiology of Colorectal Cancer, information on screening options with a focus on the importance of screening amidst COVID-19, details about the FluFIT program, and how your health system can implement an effective FluFIT program to increase Colorectal Cancer screening rates. 08/14/2020 - AHCCCS Provider Enrollment Portal (APEP) Launches August 31
As of August 31, 2020, all new providers, as well as existing providers who need to update their accounts, will use the AHCCCS Provider Enrollment Portal (APEP). This online system, available 24/7, streamlines the provider enrollment process and eliminates the need for paper-based applications. 08/04/2020 - AHCCCS Don't be the weak link in the Claim
Even if you don't submit Medicaid claims, providers who are not registered with AHCCCS, but who may be the Referring, Ordering, Prescribing, or Attending (ROPA) provider, may keep members from getting needed health care. 08/04/2020 - Billers' Corner - August 2020
Denials Due to Non-Contracted Provider Referrals 07/31/2020 - **CORRECTION** CORRECTED CLAIM/ RESUBMISSION REQUIREMENTS
In accordance with national standards and AHCCCS guidelines, effective September 1, 2020, Care1st will require the original claim number on all corrected claims, resubmissions and voids in order to prevent duplicate or timely filing denials. 07/30/2020 - CORRECTED CLAIM/ RESUBMISSION REQUIREMENTS
In accordance with national standards and AHCCCS guidelines, effective September 1, 2020, Care1st will require the original claim number on all corrected claims, resubmissions and voids in order to prevent duplicate or timely filing denials. 07/21/2020 - Billers' Corner - July 2020
Our goal is to help you reduce claims submission denials! 07/09/2020 - Immunization Program - Get Kids Back on Track with Vaccinations
The Arizona Immunization Program would like to thank you for your dedication and commitment to children's health during the COVID-19 pandemic. Ensuring the delivery of essential services, including immunizations, requires teamwork, communication, and different strategies. 07/06/2020 - CARE1ST INTEGRATED CARE TRANSFORMATION ECHO
Transforming primary care practices throughout Arizona 06/26/2020 - Vaccines for Children (VFC) Provider Enrollment Reminder
Continued participation in the VFC program requires re-enrollment every year. The re-enrollment deadline for continued participation in the Vaccines for Children Program is fast approaching. 06/22/2020 - HHS Announces Enhanced Provider Portal, Relief Fund Payments for Safety Net Hospitals, Medicaid & CHIP Providers
On June 9, 2020, the U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), announced additional distributions from the Provider Relief Fund to eligible Medicaid and Children's Health Insurance Program (CHIP) providers that participate in state Medicaid and CHIP programs. HHS expects to distribute approximately $15 billion to eligible providers that participate in state Medicaid and CHIP programs and have not received a payment from the Provider Relief Fund General Distribution. 06/12/2020 - TAPI TIPS VIRTUAL VACCINE CONVERSATIONS
TRAINING ON IMMUNIZATION PRCTICE STRATEGIES (T.I.P.S) 06/12/2020 - LIVE NATIONAL DISCUSSION - COLORECTAL CANCER SCREEN 6-18-2020
COLORECTAL CANCER SCREENING AMIDST COVID-19. CANCER DOESN'T STOP 05/29/2020 - Billers' Corner - May 2020
Claim Submission information 05/13/2020 - AHCCCS approves EPSDT visits conducted via Telehealth
In alignment with the American Academy of Pediatrics (AAP) recommendations regarding well-visits, AHCCCS is allowing providers to perform EPSDT visits via Telehealth 05/05/2020 - Provider Manual Updates
The Care1st Provider Manual has been updated (April 2020 revision date) and is available on our website 05/04/2020 - Battelle Critical Care Decontamination System
The Battelle CCDS will be available for use by healthcare providers across Arizona free of cost beginning in early May. 04/23/2020 - COVID-19 Information for AHCCCS Providers
AHCCCS Health Plans represented by the Arizona Association of Health Plans, Health Current has developed and will host a webpage that functions as a centralized resource for COVID-19 related issues impacting the Arizona Medicaid provider community 04/17/2020 - Join us for a Webinar with former SBA Administrator Hector Barreto - 4/22/2020 1:30 - 2:30 PM
Arizona Complete Health and Care1st Health Plan together are brining you expert resources to help you navigate funding opportunities made available through the Small Business Administration(SBA) and CARES Act 04/09/2020 - COVID-19: TELEHEALTH DELIVERY & BILLING
We understand that you have many questions related to COVID-19 and Telehealth Delivery & Billing. In an effort to reduce confusion and to promote a consistent message, we encourage you to visit the COVID-19 Information page on the AHCCCS website for the most up to date information: 03/19/2020 - Coronavirus Disease 2019 (COVID-19) Healthcare Provider FAQ
What is currently known about the coronavirus disease (COVID-19)? 03/19/2020 - Coconino County Arizona Health and Human Services
As we are all aware, the COVID-19 situation in Arizona continues to evolve. In recent days, a group of leaders from the Coconino County and Flagstaff community have assembled to launch community testing centers for COVID-19 03/05/2020 - AHCCCS E.V.V - Electronic Visit Verification
This notice is intended to provide an update on the EVV timeline along with a summary of upcoming information that will be posted on the EVV website 03/05/2020 - URGENT NOTICE FROM AHCCCS Vaccines for Children (VFC) Provider Notification
AHCCCS has been in conversation with the ADHS VFC Office regarding a new policy of vaccine restitution. This email is to provide providers with information that may directly impact vaccine provision for eligible EPSDT members. 03/02/2020 - COVID-19 Update for Healthcare Providers
Arizona Department of Health Services (ADHS) will be hosting a series of COVID-19 public health webinars. 02/28/2020 - Dose for Dose Restitution Exception Form
Dose for Dose Restitution Exception Form Guidance and Directions for use 02/27/2020 - FORMULARY UPDATES Effective 04/01/2020
Effective April 1, 2020, Care1st will implement the AHCCCS formulary changes based on recommendations from the January 22, 2020 AHCCCS Pharmacy & Therapeutics (P&T) Committee 02/27/2020 - PROVIDER FORUM NOTIFICATION & INVITATION
You are invited to join Care1st/WellCare as we present the Spring 2020 Provider Forum. 02/25/2020 - Sonora Quest LABORATORY REFERRALS
Sonora Quest Laboratories is the exclusive contracted outpatient lab for Care1st members. 02/25/2020 - Record Requirements for Modifiers 76/77
Effective immediately, Care1st will no longer require medical records with the initial submission of claims containing codes with a single modifier 76 and/or 77. 02/24/2020 - Billers' Corner - PRIOR AUTHORIZATION REMINDERS
Our February Billers‘ Corner is focused on Prior Authorization requirements to reduce rejections / denials 02/18/2020 - AHCCCS Provider Enrollment (APEP) Updates - New Paper Enrollment
AHCCCS has been sharing updates regarding the launch of the new AHCCCS Provider Enrollment Portal (APEP) 01/28/2020 - January Billers' Corner - REDUCING REJECTIONS/DENIALS BILLING EDUCATION TOOL
Our January Billers' Corner is focused on non-emergency transportation services pick up and drop off location billing requirements to reduce rejections/ denials for non-emergent transportation, including behavioral health 01/27/2020 - AHCCCS Provider Enrollment New Paper Application
AHCCCS has been sharing updates regarding the launch of the new AHCCCS Provider Enrollment Portal (APEP) 01/23/2020 - Care1st - AzCH Merger Close Message January 23, 2020
In Arizona, Care1st Health Plan and Arizona Complete Health-Complete Care Plan are bringing our health plans together to better serve our members, providers, partners and communities.
2019
12/30/2019 - DENTAL PROGRAM UPDATE Effective January 1, 2020 DentaQuest to administer WellCare Dental Program
In follow-up to the communication sent earlier, we want to remind you that effective January 1, 2020, DentaQuest will manage the WellCare (Medicare) Dental program. Care1st (Medicaid) transitioned to DentaQuest on October 1, 2019
2019 Holiday Hours Includes DentaQuest & Advantica Information 12/20/2019 - UPDATES TO CARE1ST MEDICAID RETAIL PHARMACY NETWORK Effective January 1, 2020
Care1st is pleased to inform you that we are expanding our Medicaid retail pharmacy network. Effective 1/1/2020, Care1st is adding 126 Safeway and Albertsons pharmacies to our Medicaid retail pharmacy network. 12/11/2019 - AZ CYE 2018 Hybrid Performance Measure Study Provider Communication
AHCCCS is preparing to collect data for the CYE 2018 Hybrid Performance Measure Study which will provide valuable quantitative information about the medical services Medicaid members received through their AHCCCS Contractors 12/06/2019 - 2019-2020 RSV (Synagis) Immunization
As RSV season approaches, it is important to make arrangements to ensure that children who need Synagis® receive injections 11/26/2019 - FORMULARY UPDATES Effective January 1, 2020
Effective January 1, 2020, Care1st will be implementing the AHCCCS formulary changes based on the recommendations from the October 16, 2019 AHCCCS Pharmacy & Therapeutics (P & T) Committee. 11/20/2019 - Non-Emergency Transportation Services Pick Up/Drop off Location Billing Requirement Reminder
Pick up and drop off locations are required on all claims for transportation services. Please note: This requirement also applies to transportation services rendered by behavioral health providers. 11/01/2019 - Electronic Prescribing of Controlled Substances (EPCS)
The purpose of this memo is to provide notification of the State of Arizona House Bill 2075 as it pertains to Electronic Prescribing of Controlled Substances and the attached additional information on available resources. 10/31/2019 - **CORRECTION** TO PRIOR AUTHORIZATION GUIDELINES Effective November 1, 2019
Following distribution of our prior communication we discovered a few codes, listed in the table below, were erroneously labeled as no authorization required. These codes currently require authorization and will continue to require authorization effective November 1, 2019. 10/25/2019 - **CORRECTION** TO PRIOR AUTHORIZATION GUIDELINES Effective November 1, 2019
Following distribution of our prior communication we discovered a few codes, listed in the table below, were erroneously labeled as no authorization required. These codes currently require authorization and will continue to require authorization effective November 1, 2019. 10/23/2019 - AHCCCS EVV Provider Welcome Letter
Beginning in 2020 and in response to a federal mandate known as the 21st Century Cures Act, AHCCCS will require providers of in-home non-skilled and skilled nursing services to use Electronic Visit Verification (EVV). 10/15/2019 - DDD Transition: Resources & Information 5th Notification
Attached are the billing requirements for pick up and drop off locations required for all transportation services, including behavioral health, to prevent denials or rejects of claims for missing/ incomplete information 09/30/2019 - DDD Transition: Resources & Information 5th Notification
Care1st is exiting the DDD line of business effective October 1, 2019. UnitedHealthcare Community Plan and Mercy Care will be the new DDD Health Plans effective October 1, 2019. 09/30/2019 - DENTAL PROGRAM UPDATE
In follow-up to the communication sent last month, we want to remind you that effective October 1, 2019, DentaQuest will manage the Care1st (AHCCCS) Dental program. The following information is meant to assist you and your office staff before, during and after the transition. 09/30/2019 - UPDATES TO PRIOR AUTHORIZATION GUIDELINES Effective November 1, 2019
The Care1st Prior Authorization Guidelines have been revised based on your feedback! 09/27/2019 - DENTAL PROGRAM UPDATE - Effective 10/1/2019
In follow-up to the communication sent last month, we want to remind you that effective October 1, 2019, DentaQuest will manage the Care1st (AHCCCS) Dental program 09/25/2019 - DENTAL PROGRAM UPDATE - Effective 10/1/2019
In follow-up to the communication sent last month, we want to remind you that effective October 1, 2019, DentaQuest will manage the Care1st (AHCCCS) Dental program 09/24/2019 - 2019-2020 FLU & ADULT VACCINE UPDATE
Routine annual influenza vaccination of all persons aged ≥ 6 months without contraindications is recommended. 09/24/2019 - DDD Transition: Resources & Information 4th Notification
Care1st is exiting the DDD line of business effective October 1, 2019. UnitedHealthcare Community Plan and Mercy Care will be the new DDD Health Plans effective October 1, 2019. 09/11/2019 - PROVIDER FORUM NOTIFICATION & INVITATION - 09/27/2019
You are invited to join Care1st as we present the Fall 2019 Provider Forum. The Provider Forum starts at 11:00AM on September 27, 2019 09/11/2019 - PROVIDER FORUM NOTIFICATION & INVITATION
You are invited to join Care1st as we present the Fall 2019 Provider Forum. The Provider Forum starts at 11:00AM on September 25, 2019 09/05/2019 - Mailing Records, Claims Correspondence and Appeals
When mailing medical records or attachments requested by Care1st please follow the guidelines attached 09/05/2019 - 2019 CULTURAL COMPETENCY CONFERENCE Wednesday, September 11, 2019
We invite you to join us for a day of cultural competency training, networking and more! 08/30/2019 - Billing Secondary Claims via 837 Effective 9/1/19
Care1st is pleased to announce that we can accept coordination of benefits information electronically for claims received September 1, 2019 and after. 08/28/2019 - FORMULARY UPDATES Effective 10/1/2019
Effective October 1, 2019 Care1st will implement the AHCCCS formulary changes based on recommendations from the May 23, 2019 AHCCCS Pharmacy & Therapeutics (P&T) Committee. 08/23/2019 - Coordination of Benefits for Dual Members Covered by WellCare Liberty and Care1st
Effective 01/01/19, ONECare, Medicare Dual Advantage plan, was rebranded to WellCare Liberty. 08/22/2019 - DDD Transition: Resources & Information 3rd Notification
Care1st is exiting the DDD line of business effective October 1, 2019. UnitedHealthcare Community Plan and Mercy Care will be the new DDD Health Plans effective October 1, 2019. 08/16/2019 - PHARMACY UPDATES FOR CARE1ST/WELLCARE
Electronic Prior Authorization Is Here! If you haven't already noticed, we are live with the Surescripts Electronic Prior Authorization solution for all of our members. 07/31/2019 - DENTAL PROGRAM UPDATE
DentaQuest chosen to administer Care1st AHCCCS and WellCare Liberty and Value Dental Programs in Arizona 07/19/2019 - DDD Transition: Resources & Information 2nd Notification
Care1st is exiting the DDD line of business effective October 1, 2019. UnitedHealthcare Community Plan and Mercy Care will be the new DDD Health Plans effective October 1, 2019. 07/01/2019 - FORMULARY UPDATES Effective 8/1/2019
Effective August 1, 2019, Care1st will be implementing the AHCCCS formulary changes based on the recommendations from the April 29, 2019 AHCCCS Pharmacy & Therapeutics (P & T) Committee. 06/25/2019 - DDD Transition: Resources & Information
Care1st is exiting the DDD line of business effective October 1, 2019. UnitedHealthcare Community Plan and Mercy Care will be the new DDD Health Plans effective October 1, 2019. 06/18/2019 - Advantica Phone Hours - June 21st
Advantica's customer service line will not be available this Friday, June 21st beginning at 9:30 am. 06/03/2019 - Care1st Medicaid Plan (AHCCCS) Migration to WellCare Postponement
We previously communicated that Care1st would integrate into our Parent Company, WellCare Health Plans. This integration was to include systems and platform changes along with a brand name change. Please be advised that the integration has been postponed for Care1st! 05/21/2019 - Medicare Claims Denying for No Authorization Prior Authorization Number on Claims
Since our migration to WellCare's claims payment system January 1, 2019, we have noticed an increase in the number of Medicare claims being denied for No Authorization Number because the Prior Authorization field on the claim form is not populated. 05/20/2019 - AHCCCS Electronic Visit Verification Survey Extension 5/28/19
AHCCCS has extended the deadline date for the EVV Provider Survey through 05/28/19 05/07/2019 - Wellcare / Centene Merger
As you may have heard, WellCare has entered into an agreement to merge with Centene. The agreement is expected to close by the first half of 2020, pending regulatory approvals and meeting closing conditions. 04/26/2019 - AHCCCS Electronic Visit Verification Survey
Beginning in 2020, AHCCCS will require Medicaid providers of personal care and home health services to use Electronic Visit Verification (EVV) pursuant to Section 1903 of the Social Security Act (42 U.S.C. 1396b). 04/26/2019 -PINAL PROVIDER FORUM NOTIFICATION & INVITATION - 05/09/2019
You are invited to join Care1st/WellCare as we present the Spring 2019 Provider Physical and Behavioral Health Provider Forum - Thursday May 9, 2019 04/26/2019 - MARICOPA PROVIDER FORUM NOTIFICATION & INVITATION - 05/02/2019
You are invited to join Care1st/WellCare as we present the Spring 2019 Provider Physical and Behavioral Health Provider Forum - Thursday May 2, 2019 04/26/2019 - COCONINO PROVIDER FORUM NOTIFICATION & INVITATION - 05/08/2019
You are invited to join Care1st/WellCare as we present the Spring 2019 Provider Physical and Behavioral Health Provider Forum - Wednesday May 8, 2019 04/26/2019 - MOHAVE PROVIDER FORUM NOTIFICATION & INVITATION SECOND NOTICE - 04/30/2019
You are invited to join Care1st/WellCare as we present the Spring 2019 Provider Physical and Behavioral Health Provider Forum - Tuesday April 30, 2019 04/23/2019 - PINAL PROVIDER FORUM NOTIFICATION & INVITATION - 05/09/2019
You are invited to join Care1st/WellCare as we present the Spring 2019 Provider Physical and Behavioral Health Provider Forum Thursday May 9th 04/16/2019 - COCONINO PROVIDER FORUM NOTIFICATION & INVITATION
You are invited to join Care1st/WellCare as we present the Spring 2019 Provider Physical and Behavioral Health Provider Forum. Wednesday May 8th 04/16/2019 - MOHAVE PROVIDER FORUM NOTIFICATION & INVITATION
You are invited to join Care1st/WellCare as we present the Spring 2019 Provider Physical and Behavioral Health Provider Forum. Tuesday April 30th 04/16/2019 - MARICOPA PROVIDER FORUM NOTIFICATION & INVITATION
You are invited to join Care1st/WellCare as we present the Spring 2019 Provider Physical and Behavioral Health Provider Forum. Thursday May 2nd 04/04/2019 - UPDATES TO PRIOR AUTHORIZATION GUIDELINES Effective May 1, 2019
Care1st/WellCare has conducted a review of services to determine the status of Behavioral Health prior authorization requirements 04/01/2019 - SPECIALTY PHARMACY NETWORK FOR CARE1ST AHCCCS Effective 4/1/2019
Effective April 1, 2019, Care1st AHCCCS only will be moving to a Specialty Network primarily for chronic disease conditions that require Specialty medications. 03/29/2019 - Claim Submission, SNIP Edits, Correspondence, Real-Time and EFT Updates New Effective Date 6/1/2019
The Care1st integration date has changed! On June 1, 2019, Care1st Health Plan Arizona Inc. (Care1st), a WellCare company, will integrate with WellCare and be known as WellCare of Arizona 03/29/2019 - Changes to EFT/835/Electronic Remittance Advices
As we integrate into WellCare and migrate to WellCare's claims payment system, we are partnering with PaySpan®, a company with more than 25 years of experience in developing payment solutions. PaySpan offers our providers electronic funds transfer (EFT) and electronic remittance advice (ERA) services at no charge. This change was effective Jan. 1, 2019, for WellCare Liberty (Medicare), formerly known as ONECare, and will be effective June 1, 2019, for Care1st (Medicaid). 03/20/2019 - Dental Clinical and Billing Guidelines Update
The Advantica/Care1st Clinical and Billing Guidelines have been updated. The updates will be effective immediately 03/15/2019 - Care1st Medicaid Plan Changes New Effective Date 6/1/2019
The Care1st integration date has changed! On June 1, 2019, Care1st Health Plan Arizona Inc. (Care1st), a WellCare company, will integrate with WellCare and be known as WellCare of Arizona. 03/14/2019 - Public Health Agencies Announce Confirmed Measles Case in Pima County
The Arizona Department of Health Services (ADHS) and the Pima County Public Health Department announced today that a 12-month-old infant from Pima County has been diagnosed with measles. 03/12/2019 - Addressing the Increase of Syphilis in Arizona
Arizona is currently in a syphilis outbreak in women and babies. Arizona now has the 4th highest rate of syphilis in the country. 03/08/2019 - 2019 Statewide Symposium in Support of Service Members, Veterans & Their Families
The Arizona Coalition for Military Families and our public & private sector planning partners invite you to attend the 2019 Statewide Symposium in Support of Service Members, Veterans & Their Families April 17-18, 2019 DESERT WILLOW CONFERENCE CENTER 03/07/2019 - IMPORTANT INFORMATION: RADIOLOGY SERVICES PRESCOTT/PRESCOTT VALLEY AREA
Care1st/WellCare contracts with Yavapai Regional Medical Center and SimonMed Imaging for Radiology services 03/01/2019 - SPECIALTY NETWORK FOR CARE1ST AHCCCS Effective 4/1/2019
Effective April 1, 2019, Care1st AHCCCS only will be moving to a Specialty Network primarily for chronic disease conditions that require Specialty medications. 02/28/2019 - Care1st/WellCare Physical Address Change Effective 3/8/2019
Our Address is changing effective 3/8/2019 - Please update your records accordingly 02/11/2019 - DENTAL INCENTIVE PROGRAM CONTINUES Correction to Advantica Contact Information
We're excited to notify you that the Care1st Dental Incentive Program, designed to reward the efforts of dentists who place a priority on prevention of dental disease in children 01/08/2019 - Medicare/ONECare Plan Changes effective 1/1/2019
Effective Jan. 1, 2019, ONECare will be known as WellCare Liberty! Same plan, new name. This D-SNP plan is offered in Maricopa, Pinal, Gila, Mohave, Coconino, Navajo, Apache and Yavapai Counties. 01/01/2019 - Claim Submission, SNIP Edits, Correspondence, Real-Time and EFT Updates Effective 1/1/2019
Effective Jan. 1, 2019, ONECare will be known as WellCare Liberty! Same plan, new name. This D-SNP plan is offered in Maricopa, Pinal, Gila, Mohave, Coconino, Navajo, Apache and Yavapai Counties
2018
12/31/2018 - Medicare/ONECare Plan Changes effective 1/1/2019Effective Jan. 1, 2019, ONECare will be known as WellCare Liberty! Same plan, new name. This D-SNP plan is offered in Maricopa, Pinal, Gila, Mohave, Coconino, Navajo, Apache and Yavapai Counties. 12/31/2018 - UPDATES TO PRIOR AUTHORIZATION GUIDELINES Effective January 1, 2019
As part of our integration into our new parent company WellCare, effective 1/1/2019 ONECare is migrating to Wellcare’s claims payment system and the ONECare name is changing to WellCare. 12/13/2018 - Claim Submission, SNIP Edits, Correspondence, Real-Time and EFT Updates Effective 1/1/2019
ONECare by Care1st Health Plan Arizona Inc. (ONECare) and Care1st Health Plan Arizona Inc. (Care1st), both WellCare Companies will be integrated and updated to new logo branding: WellCare, Beyond Healthcare. A Better You. 12/13/2018 - IMPORTANT INFORMATION: RADIOLOGY SERVICES PRESCOTT/PRESCOTT VALLEY AREA
Care1st contracts with SimonMed Imaging for Radiology services. Providers are encouraged to refer radiology services such as X-rays, Mammograms, MRIs and other radiology services directly to SimonMed 12/12/2018 - Dental Reminders
Advantica Dental Services, Inc. (Advantica) manages the dental benefits provided to Care1st members on behalf of Care1st. Prior authorizations, claim processing and claim inquiries are handled by Advantica. 11/28/2018 -TIME SENSITIVE POTENTIAL ACTION REQUIRED: ELECTRONIC PRESCRIBING Effective 1/1/2019
As part of the 2018 Opioid Epidemic Act passed by the Arizona legislature, Arizona is mandating that Schedule II opioid controlled substances should be dispensed only via an electronic prescription. 11/19/2018 - 2018 RSV SEASON UPDATE
As RSV season approaches, it is important to make arrangements to ensure that children who need Synagis® receive injections. 11/16/2018 - UPDATES TO PRIOR AUTHORIZATION GUIDELINES
Please note that there are changes that are effective immediately to the Prior Authorization Guidelines. 10/17/2018 - UPDATES TO THE PRIOR AUTHORIZATION REQUEST FORM TREATMENT AUTHORIZATION REQUEST
The Treatment Authorization Request (TAR) has been updated with additional information including the Care1st admission fax number, which is separate from the Prior Authorization fax number. 10/09/2018 - PROVIDER FORUM INVITATION - 10/29/2018 or 10/30/2018
Please join us at one of our Medical/Dental Forums at the locations below. We will review topics outlined below, be available for questions and to generally meet with you. Care1st will have representatives from multiple areas in attendance to assist and answer any questions 10/03/2018 - Tips to Help Your Patients Follow Their Treatment Plan
Here are some tips to help ensure the patient understands what you're saying about their health and well-being, as well as the medicines and tests you prescribe. 10/01/2018 -Care1st ACC October 1, 2018 Updates
AHCCCS Complete Care (ACC) Contract is effective today, October 1, 2018. The purpose of this communication is to provide details to assist you with navigating membership changes. 09/27/2018 -UPDATES TO PRIOR AUTHORIZATION GUIDELINES Effective October 1, 2018
AHCCCS has selected CVS Specialty to be the exclusive provider of hemophilia factor/Ceprotin for all AHCCCS plan members effective 10.1.18. All prescriptions for hemophilia factor/Ceprotin must dispensed through CVS Specialty and as a result hemophilia factor has been removed from the Medical Prior Authorization grid. Medical claims for hemophilia factor/Ceprotin for outpatient use will no longer be covered. 09/21/2018 -UPDATES TO PRIOR AUTHORIZATION GUIDELINES Effective October 1, 2018
AHCCCS has selected CVS Specialty to be the exclusive provider of hemophilia factor/Ceprotin for all AHCCCS plan members effective 10.1.18. All prescriptions for hemophilia factor/Ceprotin must dispensed through CVS Specialty and as a result hemophilia factor has been removed from the Medical Prior Authorization grid. Medical claims for hemophilia factor/Ceprotin for outpatient use will no longer be covered. 09/18/2018 - PROVIDER MANUAL UPDATES
Welcome to the Care1st network. We are excited to work with all of you! The purpose of this communication is to provide details to assist you while items including the Welcome Packet are in the process of being mailed. 09/19/2018 - IMPORTANT PROVIDER NOTICE REGARDING AHCCCS ELIGIBILITY AND ENROLLMENT VERIFICATION
Starting September 30, 2018 through the first week of October, with the transition to AHCCCS Complete Care (ACC), there may be a delay in posting of updates to eligibility and enrollment information to the AHCCCS Health Plans' verification systems. 09/18/2018 - PROVIDER MANUAL UPDATES
The Care1st Provider Manual has been updated (September 2018 revision date) and is available on our website 09/17/2018 - PROVIDER FORUM INVITATION - 9/25/2018
Please join us at our Medical/ Dental Forum Tuesday, September 25, 2018 8:45 AM - 11 AM 09/13/2018 - What You Need to Know About the Breast Cancer Screening Measure
Reminder: Transportation to Mammograms is a Covered Service 09/11/2018 - REDUCING DENIALS BILLING EDUCATION TOOL
The Billers' Corner was created for you and provides tips so you get paid faster! We hope you like it and appreciate your feedback on this tool or topics you would like to see in the future 09/07/2018 - Upcoming Branding, EFT, Remittance Advice, Claim Submissions & Provider Portal Changes
As part of our integration into our new parent, WellCare, and our migration to WellCare's claims payment system, we have changes underway that we want to share with you. 09/03/2018 - Prior Authorization Guideline Updates
Please note the following changes effective 10/1/2018. Review the specific PA guidelines for changes to the Behavioral Health Covered Services 09/02/2018 - Dental Clinical and Billing Guidelines. AHCCCS & DDD Members 21 and Over
This Guideline is used for Adult DDD after the $1000 benefit is used and for AHCCCS Adults. For guidelines on DDD Adult $1000 Dental Benefit, refer to Clinical and Billing Guidelines AHCCCS & DDD Members Under 21 & DDD Members Over 21 $1000 Dental Benefit 09/01/2018 - Dental Clinical and Billing Guidelines. AHCCCS & DDD Members Under 21 - DDD Members Over 21 $1000 Dental Benefit
Dental Clinical and Billing Guidelines. AHCCCS & DDD Members Under 21 - DDD Members Over 21 $1000 Dental Benefit 08/31/2018 - Dental Clinical and Billing Guidelines
The Advantica/Care1st Clinical and Billing Guidelines have been updated.The updates will be effective October 1, 2018 08/29/2018 - AHCCCS Complete Care Starts in 32 DAYS!
AHCCCS Complete Care (ACC) begins on October 1, 2018. Care1st will be an ACC contractor in the North and Central Geographic Service Areas (GSA)! 08/24/2018 - Dental Claims Data and Utilization Pattern Review
On behalf of Care1st, Advantica is reviewing dental claims data and utilization patterns. Utilization patterns were compared across the network of providers to identify potential outliers. 08/15/2018 - AHCCCS Complete Care - Fact for Providers
Today most AHCCCS members have one health plan for physical healthcare services, and one health plan for behavioral healthcare services. An ACC Plan will give members access to a single plan and network of physical and behavioral healthcare providers for services. All ACC Plans will also provide services for members with Children’s Rehabilitative Services (CRS) conditions. The ACC Plan will manage the network and all covered physical and behavioral health services. A member’s ACC Plan will be the only Medicaid payer to providers for ACC enrolled members. 08/07/2018
08/06/2018 - AHCCCS Complete Care Starts in 55 DAYS!
AHCCCS Complete Care (ACC) begins on October 1, 2018. Care1st will be an ACC contractor in the North and Central Geographic Service Areas (GSA)! The North GSA includes Mohave, Coconino, Navajo, Apache and Yavapai Counties. The Central GSA includes Maricopa, Pinal and Gila Counties. 07/25/2018 - IMPORTANT REMINDER FOR PCPS: VFC Re-enrollment EXTENDED until JULY 30!
As you know, all providers with assigned members under 19 years of age must participate in the Vaccines For Children (VFC) program to ensure the delivery of required immunizations. Providers must re-enroll each year in the VFC Program 07/20/2018 - UPDATE: HANDWRITING ON PAPER CLAIM FORMS
On June 21, 2018, we issued a communication regarding Care1st's alignment with the AHCCCS guideline regarding handwriting on claims effective June 1, 2018. The communication stated that effective August 1, 2018 and forward claims received with handwriting on any part of the claim (with the exception of handwriting on the signature field) would be returned. 07/06/2018 - UPDATES TO PRIOR AUTHORIZATION GUIDELINES Effective August 6, 2018
Changes to Prior Authorization Guidelines - Specialists and Attachment III - Effective 8/6/2018 06/26/2018 - Compliance Requirements - PAST DUE - DISREGARD IF YOU HAVE ALREADY SUBMITTED YOUR ATTESTATIONS
WE NEED YOUR HELP! The Centers for Medicare & Medicaid Services (CMS) requires Medicare plans to provide compliance related training materials to contracted providers, i.e. First tier, downstream and related entities (FDRs), and their employees who are involved in the administration or delivery of Medicare benefits. Your attestation is required as proof you received the training materials and provided them to your staff. 06/15/2018 - VFC Vaccine Restitution Policy Reminder
VFC Vaccine Restitution Policy Reminder. 06/12/2018 - IMPORTANT REMINDER FOR PCPS
VFC Re-enrollment Ends June 30. 06/01/2018 - Introducing Pacify
Now Your Patients Can Connect Face-To_Face With Lactation Consultants And Dietitians At The Touch Of A Button. 05/31/2018 - AHCCCS Complete Care: Resources & Information
AHCCCS Complete Care (ACC) begins on October 1, 2018. This new integrated system joins physical and behavioral health services together to treat all aspects of Medicaid members’ health care needs under a chosen health plan. ACC encourages more coordination between providers within the same network, which can mean better health outcomes for members. 05/30/2018 - Handwriting on paper claim forms
Effective July 1, 2018 Care1st will no longer accept claims with handwriting. 05/29/2018 - HANDS-ONLY CPR fact sheet
Why Learn Hands-Only CPR? Cardiac arrest – an electrical malfunction in the heart that causes an irregular heartbeat (arrhythmia) and disrupts the flow of blood to the brain, lungs and other organs – is a leading cause of death. Each year, more than 350,000 EMS-assessed out-of-hospital cardiac arrests occur in the United States. 05/24/2018 - Opioid Prescribing Guidelines for Chronic Non-Terminal Pain
These guidelines are intended to reduce the inappropriate use of controlled substances, improve safety, and reduce harm while preserving the vital roles of clinicians and patients in the management of acute chronic pain issues.
5/24/18 AHCCCS Complete Care: The Future of Integrated Healthcare
AHCCCS Complete Care (ACC) begins on October 1, 2018. This new integrated system will join physical and behavioral health services together to treat all aspects of our members' health care needs under a chosen health plan. AHCCCS Complete Care encourages more coordination between providers within the same network which can mean better health outcomes for members.
Here's what members need to know
Who Does AHCCCS Complete Care Affect?
- Most adults on AHCCCS *
- Most children on AHCCCS *
What's Changing
- Members will be able to access physical and behavioral healthcare services through a single ACC health plan.
- The health plan choices may change
What's Not Changing?
- Members will still have a choice of health plans in their geographic service area.
- Members will have access to the same array of covered services.
- Members will still have access to a network of providers.
- Regional Behavioral Health Authorities (RBHAs) will continue to provide specific crisis services.
- RBHAs will continue to serve members determined to have a Serious Mental Illness, children in foster care, and members served by Department of Economic Services/DDD.
- American Indian members will have the choice of enrolling in an ACC managed care plan or the American Indian Health Program (AIHP) and a Tribal RBHA when available. American Indian members will have the same access to Indian Health Services providers, Tribal 638 providers, and Urban Indian Health providers.
- Arizona Long Term Care System (ALTCS) plans will remain the same.
For more information, please visit the AHCCCS Website: AHCCCSCompleteCare
04/30/2018 - 2018 Cultural Competency Conference - May 23
Join us for a sharing of best practices to create a culture of inclusion and respect for our diverse member population and your patients. Cultural respect is critical to reducing health disparities and improving access to care. Join us for a day of networking, sharing best practices and resources, lively discussion, prizes and giveaways. 04/26/2018 - PROVIDER FORUM INVITATION 2nd Notification - May 8, 2018
Please join us at our forum Tuesday, May 8, 2018 8:45 AM - 11 AM. 04/18/2018 - Billers' Corner - April 2018
News You Can Use - Billers' Corner - April 2018 04/17/2018 - PROVIDER FORUM INVITATION - May 8, 2018
Please join us at our forum Tuesday, May 8, 2018 8:45 AM - 11 AM. 04/12/2018 - Phone System Update
In order to make improvements, we are changing our phone system on May 10, 2018. 04/11/2018 - AHCCCS dental requirements - The 1st birthday means it is time for the 1st dental visit
Care1st members under 21 years are assigned to a dental home by age 1. All members under 21 years of age must be seen by a dentist for routine preventive care according to the Dental Periodicity Schedule contained in the AHCCCS Medical Policy Manual (AMPM Exhibit 431-1). This includes a first dental visit while a child is still 1. 04/09/2018 - PROVIDER FORUM INVITATION - 5/2/2018
Dental, Behavioral Health and Medical Providers, Staff and Billing Staff Please join us at our forum Wednesday, May 2, 2018 10:45 AM - 1 PM 04/04/2018 - Compliance Requirements - Training Materials
WE NEED YOUR HELP! The Centers for Medicare & Medicaid Services (CMS) requires Medicare plans to provide compliance related training materials to contracted providers, i.e. First tier, downs tream and related entities (FDRs), and their employees who are involved in the administration or delivery of Medicare benefits. Your attestation is required as proof you received the training materials and provided them to your staff. 03/21/2018 - Save the Date - Cultural Competency Conference 5-23-2018
Join us for a sharing of best practices to create a culture of inclusion and respect for our diverse member population and your patients. Cultural respect is critical to reducing health disparities and improving access to care. Join us for a day of networking, sharing best practices and resources, lively discussion, prizes and giveaways. 03/21/2018 - Electronic Data Interchange (EDI) & Electronic Funds Transfer (EFT) Important Details
Care1st understands time-consuming administrative tasks can jeopardize time spent with patients and result in added costs for your practice. As a result, we offer technology and services that improve operational efficiencies and minimize cost. Please review the EDI and EFT options below and take advantage of them today! 03/08/2018 - PREFERRED HOMECARE INFUSION IS NOW CORUM CVS/SPECIALTY INFUSION SERVICES
Please be advised that effective 03/01/2018, Preferred Homecare Infusion, LLC in Arizona was purchased by Coram CVS/Specialty Infusion Services. 03/02/2018 - AHCCCS ELECTRONIC VISIT VERIFICATION SURVEY RESPONSES DUE 3/12/2018
In response to the Electronic Visit Verification (EVV) requirements outlined in the 21st Century Cures Act and AHCCCS’ efforts already underway to implement EVV, AHCCCS is requesting information from your organization through a survey aimed at gathering critical information. 02/18/2018 - Use of Social Determinants of Health Codes for Member Outcomes
As part of AHCCCS' efforts in developing a streamlined method of collecting and tracking member outcomes, the use of specific ICD-10 diagnosis codes representing Social Determinants of Health has been identified as a valuable source of information that impacts member health 02/06/2018 - National AHEC Organization's Upcoming Webinar
How HPV Causes Cancer and Why it Still Matters Thursday, February 15th at 3 pm EST 02/01/2018 - REDUCING DENIALS BILLING EDUCATION TOOL
February Billers‘ Corner is focused on outpatient therapy billing and also includes tips to reduce denials based on our top 5 denial reasons. 01/31/2018 - AHCCCS CHANGES TO MATERNITY CARE AND FAMILY PLANNING POLICIES
AHCCCS has revised policies related to maternity care and family planning services that affect providers.
2017
12/28/2017 - PROVIDER MANUAL UPDATES
The Care1st Provider Manual has been updated (December 2017 revision date) and is available on our website:
The Arizona Commission for the Deaf and Hard of Hearing provides training materials regarding communication access. You are encouraged to use the brochures to understand your responsibilities as a medical provider 12/18/2017 - BLOOD GLUCOSE METER & TEST STRIP UPDATE EFFECTIVE JANUARY 1, 2018
Care1st & ONECare have selected the following OneTouch products to be the exclusive glucose meters and test strips available to Care1st & ONECare members with diabetes effective January 1, 2018: 12/18/2017 - ACTION REQUIRED: ONECare Member ID Number/Card Change Effective January 1, 2018
Effective January 1, 2018, your ONECare members will have a new ID number and ID card. 12/18/2017 - CARE1ST PHARMACY NETWORK UPDATE EFFECTIVE JANUARY 1, 2018
Effective January 1, 2018, CVS Caremark will be our pharmacy benefit manager. As a result, Wal-Mart, Safeway, Albertsons\Osco Pharmacies will no longer be part of the Care1st retail pharmacy network and Walgreens will continue to be out of network 12/15/2017 - PHARMACY PRIOR AUTHORIZATION TURNAROUND TIME CHANGES EFFECTIVE JANUARY 1, 2018
Effective January 1, 2018, pharmacy prior authorization requests will be processed according to the guidelines outlined in the table attached 12/13/2017 - Practice Pointers - HPV - Why it should be given
HPV: The Centers for Disease Control and Prevention (CDC) now recommend 11-to-12-year olds get two doses of HPV vaccine — rather than the previously recommended three doses 12/04/2017 - CARE1ST PHARMACY NETWORK UPDATE EFFECTIVE JANUARY 1, 2018
Effective January 1, 2018, CVS Caremark will be our pharmacy benefit manager. 12/04/2017 - ONECare Member ID Number/Card Change Effective January 1, 2018
Effective January 1, 2018, your ONECare members will have a new ID number and ID card. 11/28/2017 - UPDATES FOR LONG-ACTING OPIOIDS - Effective January 1, 2018
The AHCCCS mandate to require prior authorization on all long acting narcotics remains in place. AHCCCS is making a few changes to the preferred formulary agents 11/28/2017 - 5-DAY SUPPLY LIMIT FOR SHORT-ACTING OPIOIDS - Effective January 1, 2018
Per the Executive Order signed by Governor Ducey, we are initiating required changes to fill limits. 11/27/2017 - AHCCCS Managed Care Providers - 2017 Provider Survey
AHCCCS is conducting a survey to determine its contracted Managed Care Organizations' (MCO's) performance and responsiveness to its providers 11/21/2017 - Care1st & ONECare 2017 Holiday Hours Notice
Care1st & ONECare 2017 Holiday Hours Notice Includes Advantica Holiday Hours for Dental Practices 11/15/2017 - 2017 RSV SEASON UPDATE
As RSV season approaches, it is important to make arrangements to ensure that children who need Synagis® receive injections. Care1st will work with your office to authorize and obtain Synagis® with no out of pocket cost. 11/13/2017 - BLOOD GLUCOSE METER & TEST STRIP UPDATE EFFECTIVE JANUARY 1, 2018
Care1st & ONECare have selected OneTouch products to be the exclusive glucose meters and test strips available to Care1st & ONECare members with diabetes effective January 1, 2018: 11/13/2017 -CARE1ST PHARMACY NETWORK UPDATE
Effective January 1, 2018, CVS Caremark will be our pharmacy benefit manager. As a result, Wal-Mart, Safeway, Albertsons\Osco Pharmacies will no longer be part of the Care1st retail pharmacy network 11/10/2017 - AHCCCS Adult $1000 Emergency Dental Benefit Prior Auth & Billing Update
The Over 21 Advantica/Care1st Clinical and Billing Guideline was just updated to include the new $1000 Adult Emergency Benefit that went into effect October 1, 2017. 11/09/2017 - UPDATES TO PRIOR AUTHORIZATION GUIDELINES
Prior Authorizations Guidelines Effective November 1, 2017. 11/01/2017 - DENTAL INCENTIVE PROGRAM CONTINUES
We’re excited to notify you that the Care1st Dental Incentive Program, designed to reward the efforts of dentists who place a priority on prevention of dental disease in children, will continue for Contract Year 2018, i.e. 10/1/17-9/30/18. 10/31/2017 - ONECare Denture Benefit Elimination
Effective January 1, 2018, dentures will no longer be a covered supplemental benefit. 10/30/2017 - ONECare Member ID Number/Card Change
Effective January 1, 2018, your ONECare members will have a new ID number and ID card. 10/09/2017 - REDUCING DENIALS BILLING EDUCATION TOOL
The Care1st Provider Billing Education Tool was created for you and provides billing tips and reminders to reduce denials and resubmissions so you get paid faster! We hope you like it and appreciate your feedback on this tool or topics you would like to see in the future. 10/06/2017 - REMINDER OF CARE1ST WEBSITE & EMAIL CHANGES
This is a follow up communication with some additional suggestions to help if you have problems accessing our new website address. 10/05/2017 - REMINDER OF CARE1ST WEBSITE & EMAIL CHANGES
This is a follow up communication with some additional suggestions to help if you have problems accessing our new website address.
10/04/2017 - FAMILY PLANNING: Important Reminders and Resources for Providers
If you participate in the Advantica Provider Incentive, it is important you know Advantica identified an error in the processing of your 2016-2017 provider incentive payments. All incentive payment errors were corrected on your 9/28/2017 remittance advice.
10/02/2017 - Advantica Payment September 28, 2017
If you participate in the Advantica Provider Incentive, it is important you know Advantica identified an error in the processing of your 2016-2017 provider incentive payments. All incentive payment errors were corrected on your 9/28/2017 remittance advice.
9/29/2017 - Dental Clinical and Billing Guidelines Update For AHCCCS and DDD Members 21 and Over
Effective October 1, 2017, the Advantica/Care1st Clinical and Billing Guidelines have been updated.
9/27/2017 -AHCCCS Benefit Changes Effective October 1, 2017
As part of the 2017 Legislative session, the Arizona Legislature passed Senate Bill 1527. AHCCCS plans to begin coverage of the following services effective October 1, 2017. The benefit limitations are based on contract year which is October 1 to September 30.
9/26/2017 -REMINDER OF CARE1ST WEBSITE & EMAIL CHANGES
This is a follow up communication with some additional suggestions to help if you have problems accessing our new website address.
9/21/2017 -2017-18 FLU & ADULT VACCINE UPDATE
Routine annual influenza vaccination of all persons aged ≥6 months without contraindications is recommended.
9/12/2017 - REMINDER: LABORATORY REFERRALS
Sonora Quest Laboratories is the exclusive contracted outpatient lab for Care1st and ONECare members. Sonora Quest is a full service lab and is able to perform all lab tests, including complete drug screenings and maternity workups.
9/11/2017 - AHCCCS Requirements for Well Woman Preventive Care
Our Quality Improvement Department would like to remind you that an annual well-woman visit is a covered benefit for AHCCCS-enrolled women, and is intended to identify risk factors for disease and any existing medical/mental health problems.
9/06/2017 - Provider Forum Invitation 2nd Notification
Dental and Medical Providers, Staff and Billing Staff - Please join us at our forum Wednesday, September 29, 2017 10:45 AM - 1 PM.
9/05/2017 - Provider Forum Invitation 2nd Notification
Dental and Medical Providers, Staff and Billing Staff - Please join us at our forum Wednesday, September 13, 2017 8:45 AM - 11 AM.
9/01/2017 - CARE1ST CHANGES - ACTION REQUIRED
Provider Network Operations is now Network Management. In addition, our email addresses and our website address have changed!
9/01/2017 - Minimum Subcontract Provisions
AHCCCS made a number of updates to the Minimum Subcontract Provisions effective October 1, 2017.
8/24/2017 - Provider Forum Invitation
Dental and Medical Providers, Staff and Billing Staff - Please join us at our forum Wednesday, September 13, 2017 8:45 AM - 11 AM.
8/22/2017 - Provider Forum Invitation
Please join us at our forum Wednesday, September 20, 2017 10:45 AM -1 PM.
8/04/2017 - Back to School Well Visits
When parents or guardians of Care1st members call to schedule an appointment in the next two months, be sure to schedule a comprehensive EPSDT (well) visit, and increase your reimbursement for the visit.
7/26/2017 - Provider Enrollment Requirement for Writing Prescriptions for Medicare Members!
The Centers for Medicare and Medicaid Services (CMS) finalized regulation CMS-4159-F. This regulation requires all providers, including dentists, who write prescriptions for Medicare enrollees, to be enrolled with CMS in an approved status or have a valid opt-out affidavit on file.
7/18/2017 - UPDATES TO PRIOR AUTHORIZATION GUIDELINES - Effective August 18, 2017
The Centers for Medicare and Medicaid Services (CMS) finalized regulation CMS-4159-F. This regulation requires all providers, including dentists, who write prescriptions for Medicare enrollees, to be enrolled with CMS in an approved status or have a valid opt-out affidavit on file.
7/11/2017 - CARE1ST WEBSITE ISSUES - Please read!
Last weekend, Care1st performed a system update. The system update was tested prior to implementation and identified no issues. However, after hearing from some of you late yesterday and today, it appears the update may have broken your saved link/favorite for our website....
6/28/2017 - OUR SENATORS WANT TO HEAR WHAT YOU THINK
The Arizona Health Care Cost Containment System (AHCCCS) has compiled an analysis of the American Health Care Act (as passed by the U.S. House of Representatives) and the Better Care Reconciliation Act (BCRA) (as released by the U.S. Senate on June 22, 2017)...
6/26/2017 - Dental Clinical and Billing Guidelines Update For AHCCCS and DDD Members Under 21 and DDD Members Over 21
Effective immediately, the Advantica/Care1st Clinical and Billing Guidelines have been updated. The table below outlines the changes to the AHCCCS and DDD Members Under 21 and DDD Members Over 21 Clinical and Billing Guideline....
6/20/2017 - VOLUNTARY RECALL NOTICE: ELIQUIS 5MG TABLETS
Please be aware that Bristol-Myers Squibb voluntarily recalled one lot of Eliquis 5mg tablets due to a customer complaint that one bottle of Eliquis 5mg was found to contain Eliquis 2.5mg tablets...
5/22/2017 - REDUCING DENIALS BILLING EDUCATION TOOL
The Care1st Provider Billing Education Tool was created for you and provides tips and reminders to reduce denials and resubmissions so you get paid faster! We hope you like it and would appreciate your feedback on this tool or topics you would like to see in the future...
5/18/2017 - Trainings on Immunization Practice Strategies (TIPS). Sponsored by TAPI
You are encouraged to attend this free annual training sponsored by The Arizona Partnership for Immunization (TAPI).
5/18/2017 - PROVIDER MANUAL UPDATES & PROVIDER NETWORK SPRING MAILING
The Care1st Provider Manual has been updated (May 2017 revision date) and is available on our website. In addition to a link to the complete manual, each section of the manual has its own link. You may view, search and print as needed. The table below outlines the changes made by section.
4/21/2017 - Compliance Requirements
WE NEED YOUR HELP! AHCCCS and The Centers for Medicare & Medicaid Services (CMS) require our plan to provide compliance related training materials to contracted providers and their employees who are involved in the administration or delivery of benefits...
4/19/2017 - REMINDER: 7-DAY SUPPLY LIMIT FOR SHORT-ACTING OPIOIDS
Per the Executive Order signed by Governor Ducey, we are initiating the changes outlined below to ensure short acting narcotics are initiated and continued appropriately...
4/18/2017 - Cultural Competency Conference
Connecting to Care! Embracing diversity! Join us for a sharing of best practices to create a culture of inclusion and respect for our diverse members and
your patients....
4/10/2017 - Dental Clinical and Billing Guidelines Correction for Members Under 21
Care1st made a correction to the February 1, 2017 version of the Dental Clinical and Billing Guidelines...
4/3/2017 - REMINDER: 7-DAY SUPPLY LIMIT FOR SHORT-ACTING OPIOIDS
Per the Executive Order signed by Governor Ducey, we are initiating the changes outlined below to ensure short acting narcotics are initiated and continued appropriately...
3/28/2017 - PROVIDER FORUM INVITATION 2nd Notification
The presentation will have some medical topics and plan information; however, the majority of time will be focused on dental policies and guidelines. Care1st will raffle various prizes, provide useful updates and food...
3/23/2017 - Billing for Phoenix Health Plan Members That Transition to Care1st
Previous Care1st communications provided some guidance regarding the transfer of Phoenix Health Plan (PHP) members to Care1st effective May 1, 2017...
3/15/2017 - Cultural Competency Conference
Connecting to Care. Embracing cultural aspects to improve health outcomes. Join us for a sharing of best practices to create a culture of inclusion and respect for our diverse member
population and your patients...
3/14/2017 - Phoenix Health Plan Members Transition to Care1st May 1
WellCare, parent company of Care1st, and Tenet, parent company of Phoenix Health Plan (PHP) entered into an agreement to transfer members of PHP to Care1st effective May 1, 2017 and AHCCCS has approved the agreement...
3/10/2017 - PROVIDER FORUM INVITATION
The presentation will have some medical topics and plan information; however, the majority of time will be focused on dental policies and guidelines. Care1st will raffle various prizes, provide useful updates and food...
3/10/2017 - Compliance Requirements
WE NEED YOUR HELP! AHCCCS and The Centers for Medicare & Medicaid Services (CMS) require our plan to provide compliance related training materials to contracted providers and their employees who are involved in the administration or delivery of benefits...
2/23/2017 - Patients, caregivers and healthcare providers are invited to join the American Lung Association in Phoenix
at a forum to learn about the latest in treatments, medications, resources and research in lung cancer and
other lung diseases to help those living with lung disease lead healthier, active lives. Space is limited!...
2/16/2017 - 7-DAY SUPPLY LIMIT FOR SHORT-ACTING OPIOIDS
Per the Executive Order signed by Governor Ducey, we are initiating the changes outlined below to ensure short acting narcotics are initiated and continued appropriately...
2/2/2017 - Medicare Outpatient Observation Notice (MOON)
On August 6, 2015, Congress enacted the Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act, which requires all hospitals and critical access hospitals (CAHs) to provide written notification and an oral explanation of such notification to members receiving observation services as outpatients for more than 24 hours...
2/1/2017 - PROVIDER FREQUENTLY ASKED QUESTIONS - Agreement to Transfer Phoenix Health Plan Members to Care1st
WellCare, parent company of Care1st, and Tenet, parent company of Phoenix Health Plan (PHP) have entered into an agreement to transfer members of PHP to Care1st. PHP notified its providers of this proposed change on February 1, 2017. Members will transition to Care1st effective May 1, 2017...
2/1/2017 - Agreement to Transfer Phoenix Health Plan Members to Care1st
WellCare, parent company of Care1st, and Tenet, parent company of Phoenix Health Plan (PHP) have entered into an agreement to transfer members of PHP to Care1st. Members will transition to Care1st effective May 1, 2017...
1/31/2017 - Compliance Requirements
WE NEED YOUR HELP! The Centers for Medicare & Medicaid Services (CMS) requires Medicare plans to provide compliance related training materials to contracted providers...
1/18/2017 - Dental Electronic Claims Submission (EDI), Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) Options
Care1st understands that time-consuming administrative tasks can jeopardize time spent with patients and result in added costs for your practice...
1/12/2017 - Current Dental EFT Providers RedCard EFT Registration
In an effort to provide the best possible service, Advantica is changing its EFT vendor to RedCard Systems, effective February 1, 2017...
1/9/2017 - UPDATES FOR LONG-ACTING OPIOIDS
Per the AHCCCS mandate to require prior authorization on all long acting narcotics, we are initiating the changes...
2016
12/29/2016 - Dental Prior Authorization Changes for Members Under 21. Effective February 1, 2017
Representatives from the AZ Dental Association met with AHCCCS earlier this year and presented a list of improvements for AHCCCS to consider...
12/20/2016 - PCSS-MAT to Offer Free 24-hour Required Coursework for NPs and PAs
Providers' Clinical Support System for Medication Assisted Treatment (PCSS-MAT) will provide at no cost the required 24 hours of coursework for nurse practitioners (NP) and physician assistants (PA) to prescribe buprenorphine for the treatment of opioid use disorders...
12/19/2016 - 2016-2017 FLU & ADULT VACCINE UPDATE
We want to remind our Care1st PCPs that children under the age of 19 years must receive the influenza vaccine through the Vaccines for Children (VFC) program...
12/14/2016 - Opioid Prescribing Guidelines for Chronic Non-Terminal Pain By Arizona Department of Health Services (ADHS) and CDC Guidelines
These guidelines are intended to reduce the inappropriate use of controlled substances, improve safety, and reduce harm while preserving the vital roles of clinicians and patients in the management of acute chronic pain issues...
12/01/2016 - New ONECare Denture Benefit Effective January 1, 2017
ONECare is excited to announce the addition of a new supplemental benefit for dentures...
11/29/2016 - E-Prescribing
E-prescribing is a recognized and proven effective tool to improve members’ health outcomes and reduce costs...
11/22/2016 - Care1st & ONECare 2016 Holiday Hours Notice. Includes Advantica Holiday Hours for Dental Practices
All of us here at Care1st & ONECare wish you a wonderful holiday season and we thank you very much for the care you provide to our members.
11/16/2016 - BILATERAL BILLING EDUCATION TOOL
The Care1st Provider Billing Education Tool was created to provide tips and reminders to reduce claim errors and resubmissions so you get paid faster! We hope you like it and would appreciate your feedback...
11/09/2016 - LONG ACTING REVERSIBLE CONTRACEPTIVES (LARC)
Research strongly indicates many repeat births can be prevented through postpartum use of LARC. Offering women LARC in the hospital after delivery makes it easier for women to avoid unintended pregnancy...
10/28/2016 - 2016 RSV SEASON UPDATE
As RSV season approaches, it is important to make arrangements to ensure that children who need Synagis® receive injections. Care1st will work with your office to authorize and obtain Synagis® with no out of pocket cost...
10/27/2016 - PROVIDER NETWORK FALL/WINTER MAILING
The 2016 Fall/Winter Provider Network Operations Mailing and Quick Reference Guide are available on our website...
10/14/2016 - Provider Enrollment Requirement for Writing Prescriptions for Medicare Members!
The Centers for Medicare and Medicaid Services (CMS) finalized regulation CMS-4159-F. This regulation requires all providers, including dentists, who write prescriptions for Medicare enrollees...
10/10/2016 - Medical Record Review Notification
The Arizona Medicaid Health Plans have aligned efforts under the Arizona Association of Health Plans (AzAHP) to conduct Medical Record Reviews(MRR), similar to the coordinated credentialing process implemented in 2012...
10/07/2016 - Coverage Changes for Dental Benefits for DDD Members
AHCCCS has expanded its coverage of dental benefits for DDD members who are 21 years and older. Also included the Clinical and Billing Guidelines for Members under 21 (Care1st/Advantica)...
10/05/2016 - UPDATE!
We are pleased to inform you that WellCare Health Plans, Inc. announced today it has entered into an agreement to acquire Care1st Health Plan Arizona, Inc. and ONECare by Care1st Health Plan Arizona, Inc...
10/04/2016 - Provider Manual Updates
The Care1st Provider Manual has been updated (October 2016 revision date) and is available on our website. In addition to a link to the complete manual, each section of the manual is set up with its own link...
DENTAL INCENTIVE PROGRAM CONTINUES - 09/30/2016
We're excited to notify you that the Care1st Dental Incentive Program, designed to reward the efforts of dentists who place a priority on prevention of dental disease in children, will continue for Contract Year 2017...
Zika Prevention - 09/22/2016
To date, Arizona has had over 30 travel-associated cases of Zika, and 0 locally-acquired cases.
First-Tier, Downstream, and/or Related Entities (FDRs) Annual Contractors' Compliance Risk Assessment (CRAs) - 09/15/2016
The Centers for Medicare & Medicaid Services (CMS) require that Care1st and ONECare develop procedures to promote and ensure that all its contracted FDRs are in compliance with all applicable laws...
ATTENTION! - PROVIDER FORUM INVITATION - 2nd Notification - 09/13/2016
We are holding a provider forum on Wednesday, September 28, 2016 8:45AM -11AM. Please join us!...
E-Prescribing Controlled Substances - 09/12/2016
It is legal to E-Prescribe Controlled Substances (EPCS). Here are the benefits of EPCS...
AHCCCS EHR Incentive Program - IMPORTANT DEADLINE - 09/09/2016
The Arizona Health Care Cost Containment System (AHCCCS) EHR Incentive Program provides incentive payments to certain Medicaid health care providers who adopt and use Electronic Health Record (EHR) technology in ways that can positively affect patient care....
PROVIDER FORUM INVITATION - 09/06/2016
We are holding a provider forum on Wednesday, September 28, 2016 8:45AM-11PM at the location below. Please join us!...
PROVIDER FORUM INVITATION - 09/02/2016
We are holding a provider forum on Wednesday, September 21, 2016 10:45AM-1PM at the location below. Please join us!...
BILLER'S CORNER – TIPS FOR FQHCs - 08/31/2016
Please check out our website for the August Biller''s Corner! This month focuses on tips for FQHCs...
AHCCCS Benefit Changes. Dental Benefits for DDD Members - 08/29/2016
Coverage Changes for Dental Benefits for DDD Members 21 Years and Older...
AHCCCS Benefit Changes. Coverage for Podiatry Services - 08/24/2016
Change in Coverage for Podiatry Services Effective October 1, 2016...
Opioid Prescribing Guidelines for Chronic Non-Terminal Pain By Arizona Department of Health Services (ADHS} and CDC Guidelines - 08/19/2016
These guidelines are intended to reduce the inappropriate use of controlled substances, improve safety, and reduce harm while preserving the vital roles of clinicians and patients in the management of acute chronic pain issues...
PROVIDER MANUAL UPDATES - 08/18/2016
The ONECare Provider Manual has been updated (August 2016 revision date) and is available on our website. In addition to a link to the complete manual, each section of the manual is set up with its own link. You may view, search and print as needed...
UPDATES TO PRIOR AUTHORIZATION GUIDELINES - 08/15/2016
Please note the following changes effective 9/15/2016...
AHCCCS Update: Minimum Subcontract Provisions - 08/09/2016
AHCCCS made the following updates to the Minimum Subcontract Provisions. These changes are effective October 1, 2016...
E-Prescribing Controlled Substances - 08/08/2016
It is legal to E-Prescribe Controlled Substances (EPCS). Here are the benefits of EPCS...
AHCCCS Requirements for Well Woman Preventive Care - 07/29/2016
An annual well-woman visit is a covered benefit for AHCCCS-enrolled women, and is intended to identify risk factors for disease and existing medical/mental health problems...
PROVIDER KIDSCARE APPLICATIONS ARE NOW BEING ACCEPTED! - 07/28/2016
Care1st is looking for your feedback regarding our future provider forums. We have created a survey to obtain direct input from you and appreciate you taking the time to assist us in making the provider forum a productive and informative event...
PROVIDER KIDSCARE APPLICATIONS ARE NOW BEING ACCEPTED! - 07/27/2016
KidsCare is an affordable option for medical insurance for children of working families.
Families across Arizona who earn too much to qualify for the Arizona Health Care Cost Containment System...
Provider Enrollment Requirement for Writing Prescriptions for Medicare Members! - 07/20/2016
The Centers for Medicare and Medicaid Services (CMS) finalized regulation CMS-4159-F. This regulation requires all providers, including dentists, who write prescriptions for Medicare enrollees, to be enrolled with CMS in an approved status or have a valid opt-out affidavit on file...
Modifier 59, XE, XS and XU decreased record requirement update! - 07/01/2016
PROVIDER NETWORK SUMMER MAILING & BILLING - 06/30/2016
The 2016 Summer Provider Network Operations Mailing available on our website...
Provider Enrollment Requirement for Writing Prescriptions for Medicare Members! - 06/08/2016
The Centers for Medicare and Medicaid Services (CMS) finalized regulation CMS-4159-F. This regulation requires all providers, including dentists, who write prescriptions for Medicare enrollees, to be enrolled with CMS in an approved status or have a valid opt-out affidavit on file...
INTERACTIVE VOICE RESPONSE (IVR) SYSTEM SUNSETS EFFECTIVE JULY 1, 2016 - 06/02/2016
The IVR option on our phone system used for automated member eligibility verification and claims status is outdated, unreliable, and doesn't meet current security requirements...
Notice to Providers - MEASLES - 06/01/2016
The Arizona Department of Health Services (ADHS), Maricopa County Department of Public Health, and Pinal County Public Health Services...
Restoring KidsCare Coverage: Accepting Applications Beginning July 26, 2016 for Coverage Effective September 1, 2016 - 05/24/2016
Governor Doug Ducey signed SB 1475, restoring KidsCare coverage to children in households between 133% and 200% of the Federal Poverty Limit (FPL)...
Maximize Reimbursement and Minimize Missed Opportunities - 05/23/2016
Make Sure Kids and Teens are Up to Date with EPSDT (Well) Screenings. Care1st staff is working hard to get children and teens into your office for well visits according to the AHCCCS EPSDT Periodicity Schedule.
INTERACTIVE VOICE RESPONSE (IVR) SYSTEM SUNSETS EFFECTIVE JULY 1, 2016 FOLLOW UP REMINDER - 05/17/2016
The IVR option on our phone system used for automated member eligibility verification and claims status is outdated, unreliable, and doesn't meet current security requirements...
Provider Enrollment Requirement for Writing Prescriptions for Medicare Members! - 05/12/2016
The Centers for Medicare and Medicaid Services (CMS) finalized regulation CMS-4159-F. This regulation requires all providers, including dentists, who write prescriptions for Medicare enrollees, to be enrolled with CMS in an approved status or have a valid opt-out affidavit on file...
INTERACTIVE VOICE RESPONSE (IVR) SYSTEM SUNSETS EFFECTIVE JULY 1, 2016 - 04/29/2016
The IVR option on our phone system used for automated member eligibility verification and claims status is outdated...
Dental Electronic Claims Submission (EDI), Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) Options - 04/26/2016
Care1st understands time consuming administrative tasks jeopardize time spent with patients and result in added costs for your practice...
Advantica Dental Provider Portal - Videos Now Available! - 04/8/2016
Attend the Breathe Easy Summit! 04/05/2016
Learn how to reduce the impact of Chronic Lower Respiratory Disease. We will provide the information you need to help patients and reduce the
impact of Chronic Lower Respiratory Disease (CLRD)!...
GENERAL MENTAL HEALTH AND SUBSTANCE ABUSE BILLING REMINDERS - 03/29/2016
Effective 10/01/15, AHCCCS integrated general mental health and substance abuse services (GMH/SA) for Dual (Medicare/Medicaid) adult members, i.e. 18 and older...
Care1st Provider Portal Enhancements - 03/29/2016
Recently, Care1st made several enhancements to the Member Eligibility section of the secure Provider Portal. The look and feel was updated, and additional data fields added to make the information more meaningful and useful for users...
PT/OT/ST PRACTITIONER CREDENTIALING REQUIREMENT CHANGE EFFECTIVE IMMEDIATELY - 03/25/2016
The AHCCCS Medical Policy Manual Chapter 900, Policy 950 Credentialing and Recredentialing Processes was updated October 2015 to require credentialing of Physical, Occupational and Speech Therapy practitioners...
AHCCCS EPSDT UPDATE. REVISION TO THE OCULAR PHOTOSCREENING CPT CODE - 03/25/2016
Effective April 1, 2016, AHCCCS is updating its guideline on which CPT is used to report Ocular Photo Screening with interpretation and report...
Provider Enrollment Requirement for Writing Prescriptions for Medicare Members! - 03/11/2016
The Centers for Medicare and Medicaid Services (CMS) finalized regulation CMS-4159-F. This regulation requires all providers, including dentists, who write prescriptions for Medicare enrollees, to be enrolled with CMS in an approved status or have a valid opt-out affidavit on file...
E-Prescribing Controlled Substances - 03/14/2016
It is legal to E-Prescribe Controlled Substances (EPCS). Here are the benefits of EPCS...
SONORA QUEST - 03/03/2016
Sonora Quest Laboratories is the exclusive contracted outpatient lab for Care1st and ONECare members...
UPDATES TO PRIOR AUTHORIZATION GUIDELINES (Effective April 1, 2016) - 03/01/2016
Please note the following changes effective 4/1/2016...
DIAGNOSIS CODE BILLING REMINDER - 02/29/2016
ICD-10 coding reminder. Our most common denial reason related to ICD-10 coding is due to the omission of the 4th or subsequent alpha/numeric characters used for...
ATTENTION! ATTENTION! PROVIDER FORUM INVITATION - 02/23/2016
We are holding a provider forum on Friday, March 11, 2016 11AM-1PM at the location below. Please join us!...
Dental Clinical and Billing Guidelines Update - 02/17/2016
Effective immediately, the Advantica/Care1st Clinical and Billing Guidelines have been updated. The table below outlines the changes for Members under 21 and Members over 21....
ATTENTION! ATTENTION! PROVIDER FORUM INVITATION - 02/17/2016
We are holding a provider forum on Friday, March 11, 2016 11AM-1PM at the location below. Please join us!...
E-Prescribing Controlled Substances - 02/16/2016
It is legal to E-Prescribe Controlled Substances (EPCS). Here are the benefits of EPCS...
Provider Enrollment Requirement for Writing Prescriptions for Medicare Members! - 02/12/2016
The Centers for Medicare and Medicaid Services (CMS) finalized regulation CMS-4159-F. This regulation requires all providers, including dentists, who write prescriptions for Medicare enrollees...
ADVANCE CARE PLANNING- 02/05/2016
Help patients express their wishes by providing information on advance directives, and documenting discussions in the medical record...
Arizona Department of Health Services (ADHS)- 02/01/2016
Opioid Prescribing Guidelines for Emergency Department (ED)
Arizona Department of Health Services (ADHS)- 02/01/2016
Opioid Prescribing Guidelines for Chronic Non-Terminal Pain
Dental Electronic Claims Submission (EDI), Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) Options - 01/14/2016
Care1st understands that time-consuming administrative tasks can jeopardize time spent with patients and result in added costs for your practice...
Advantica Provider Portal Enhancements! - 01/12/2016
Care1st’s dental partner, Advantica, has recently enhanced their website to allow providers to view claims status and remittance advices across all locations and all providers simultaneously through the Provider Portal!...
Provider Enrollment Requirement for Writing Prescriptions for Medicare Members! - 12/22/2015
The Centers for Medicare and Medicaid Services (CMS) finalized regulation CMS-4159-F. This regulation requires all providers, including dentists, who write prescriptions for Medicare enrollees, to be enrolled with CMS in an approved status or have a valid opt-out affidavit on file...
E-Prescribing Controlled Substances- 11/13/2015
It is legal to E-Prescribe Controlled Substances (EPCS). Here are the benefits of EPCS...
UPDATE REGARDING THE WORK WE DO FOR MERITUS - 11/11/2015
Many of you are also contracted with Meritus and likely received the November 10th communication from Meritus informing you that on October 30, 2015, Meritus was placed under a...
2015 RSV SEASON UPDATE - 11/04/2015
As RSV season approaches, it is important to make arrangements to ensure that children who need Synagis® receive injections. Care1st will work with your office to authorize and obtain Synagis® with no out of pocket cost...
Reimbursement of EPSDT & Sick Visits And Vaccine Reminders - 11/03/2015
For members less than 21 years of age, Care1st reimburses both the EPSDT and Sick visit when performed on the same day...
DENTAL INCENTIVE PROGRAM UPDATE - 10/30/2015
Care1st and our dental administrator, Advantica, want to thank you and provide an update to all providers currently enrolled in the Dental Incentive Program.
2015 FLU & ADULT VACCINE UPDATE - 10/16/2015
We want to remind our Care1st PCPs that children under the age of 19 years must receive the influenza vaccine through the Vaccines for Children (VFC) program.
AHCCCS Policy Update: Commercial Oral Nutritional Supplements - 10/15/2015
AHCCCS revised AMPM Policies 310-GG Nutritional Assessments and Nutritional Therapy and EPSDT Services 430 including Exhibit 430-2 effective October 1, 2015.
The Network to Develop a Statewide Plan for Integrated Physical & Behavioral HIE - 10/13/2015
The Network, Arizona's statewide HIE operated by Arizona Health-e Connection (AzHeC), has begun the development of a statewide plan to integrate physical and behavioral health information exchange (HIE) under one infrastructure.
ICD-10 IS HERE! - 09/30/2015
ICD-10 replaces the current ICD-9 coding for the classification of disease or health condition, symptoms, and causes, used by hospitals, providers, and others, and is required to be implemented for outpatient dates of service on or after October 1, 2015 and inpatient dates of discharge on or after October 1, 2015.
COUNTDOWN TO ICD-10!. - 09/25/2015
We are actively testing claims containing ICD-10 codes with select providers rendering a broad spectrum of services. To-date test results for ICD-10 claims processing and remit generation have been successful...
NEGATIVE PRESSURE WOUND THERAPY NETWORK UPDATE - 09/24/2015
Effective immediately, the Care1st & ONECare durable medical equipment provider for Negative Pressure Wound Therapy (Wound Vac) is...
COUNTDOWN TO ICD-10!. - 09/18/2015
We are actively testing claims containing ICD-10 codes with select providers rendering a broad spectrum of services. To-date test results for ICD-10 claims processing and remit generation have been successful...
Behavioral Health Providers/ AHCCCS General Mental Health and Substance Abuse for Dual Eligible Members - 09/17/2015
Effective October 1, 2015, AHCCCS Acute contractors such as Care1st take over responsibility for coordinating care and acting as the secondary insurance for general mental health and substance abuse services for Medicaid members that also qualify for Medicare, i.e. dual eligibles...
Care1st Primary Care Physicians and Staff/ AHCCCS General Mental Health and Substance Abuse for Dual Eligible Members - 09/17/2015
Effective October 1, 2015, AHCCCS Acute contractors such as Care1st take over responsibility for coordinating care and acting as the secondary insurance for general mental health and substance abuse services for Medicaid members that also qualify for Medicare, i.e. dual eligibles...
AHCCCS Survey Communication - Provider Survey Regarding Claims and Resolution - 09/16/2015
AHCCCS is conducting a survey to ascertain providers' level of satisfaction with Claims Processing and Resolution by its contracted Health Plans...
COUNTDOWN TO ICD-10!. - 09/11/2015
We are actively testing claims containing ICD-10 codes with select providers rendering a broad spectrum of services. To-date test results for ICD-10 claims processing and remit generation have been successful...
Dental Clinical and Billing Guidelines Update (Effective 09/01/2015) - 09/03/2015
Effective immediately, the Advantica/Care1st Clinical and Billing Guidelines have been updated...
Pima County RBHA Transition (Effective 10/1/15) - 09/01/2015
Pima County RBHA Transition from Community Partnership of Southern Arizona (CPSA) to Cenpatico for SMI and Non-SMI Services!...
DENTAL INCENTIVE PROGRAM - 09/01/2015
We're excited to present to you a new Care1st Dental Incentive Program designed to reward the efforts of dentists who place a priority on prevention of dental disease in children..
UPDATES TO PRIOR AUTHORIZATION GUIDELINES - 08/31/2015
Effective October 1, 2015, Care1st is responsible for coordinating care and acting as the secondary insurance for general mental health and substance abuse services for Medicaid members...
COUNTDOWN TO ICD-10!.
We are actively testing claims containing ICD-10 codes with select providers rendering a broad spectrum of services
Million Hearts® : Cardiovascular Disease Risk Reduction Model Request for Applications.
Million Hearts®: Cardiovascular Disease Risk Reduction Model (MH Model) supports both the Million Hearts' goal to prevent one million heart attacks and strokes and CMS' objective to identify and spread better models of care delivery and payment.
PROVIDER FORUM INVITATION - 2nd Notice.
We are holding a provider forum on Tuesday, September 1, 2015 11AM-1PM at the location below. Please join us!
Behavioral Health Providers and Staff.
AHCCCS General Mental Health and Substance Abuse for Dual Eligible Members
Effective October 1, 2015, AHCCCS Acute contractors such as Care1st take over responsibility for coordinating care and acting as the secondary insurance for general mental health and substance abuse services for Medicaid members that also qualify for Medicare, i.e. dual eligibles...
Care1st Primary Care Physicians and Staff.
AHCCCS General Mental Health and Substance Abuse for Dual Eligible Members
Effective October 1, 2015, AHCCCS Acute contractors such as Care1st take over responsibility for coordinating care and acting as the secondary insurance for general mental health and substance abuse services for Medicaid members that also qualify for Medicare, i.e. dual eligibles...
Change in Coverage for Orthotic Devices
Change in Coverage for Orthotic Devices for Members Who Are 21 Years and Older - Effective August 1, 2015 - 08/06/2015...
PROVIDER FORUM INVITATION
We are holding a provider forum on Tuesday, August 25, 2015 11AM-1PM at the location below. Please join us!...
Provider Enrollment Requirement for Writing Prescriptions for Medicare Members! - 07/16/2015
The Centers for Medicare and Medicaid Services (CMS) finalized regulation CMS-4159-F. This regulation requires all providers, including dentists, who write prescriptions for Medicare enrollees, to be enrolled with CMS in an approved status or have a valid opt-out affidavit on file...
UPDATES TO PRIOR AUTHORIZATION GUIDELINES - 07/15/2015
Other service additions to our Prior Authorization Guidelines effective August 15, 2015...
Provider Network Operations Mailing 2015 - 07/13/2015
The 2015 Summer Provider Network Operations Mailing and Quick Reference Guide are available here on our website...
ICD-10 Implementation Reminder! - 06/29/2015
In February 2015, the House of Representatives' Energy and Commerce Committee's Subcommittee on Health held a hearing on the transition to ICD-10...
UPDATES TO THE TREATMENT AUTHORIZATION REQUEST FORM - 06/25/2015
We have updated our Treatment Authorization Request (TAR) form. The following fields have been added...
Provider Enrollment Requirement for Writing Prescriptions for Medicare Members! - 06/02/2015
The Centers for Medicare and Medicaid Services (CMS) finalized regulation CMS-4159-F. This regulation requires all providers, including dentists, who write prescriptions for...
AHCCCS Update - Minimum Subcontract Provisions - 06/01/2015
Dental Guide - Electronic Claims Submission, Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) Options- 05/15/2015
Care1st understands that time-consuming administrative tasks can jeopardize time spent with patients and result in added costs for your practice...
CORRECTION to Effective Date!!- 04/22/2015
Benefit Coordination and Fiscal Responsibility for Behavioral Health Services and Physical Health Services (Effective April 1, 2015)...
AHCCCS Policy Update- 04/20/2015
Benefit Coordination and Fiscal Responsibility for Behavioral Health Services and Physical Health Services...
IMPORTANT! - AHCCCS FQHC/ RHC PPS Implementation Reminders - 04/20/2015
Effective for dates of service April 1, 2015 and after, AHCCCS health plans implemented payment of the FQHC/RHC specific PPS rate...
Provider Forum Feedback - 04/16/2015
Care1st recently conducted Provider Forums in Maricopa and Pima County. Thank you to all that took time out of your busy schedules to meet with the Care1st team...
Compliance Requirements - 04/13/2015
WE NEED YOUR HELP! The Centers for Medicare & Medicaid Services (CMS) requires Medicare plans to provide compliance related training materials to contracted providers...
PROVIDER FORUM INVITATION, MARICOPA COUNTY - 03/13/2015
We are holding a provider forum on Tuesday, March 31, 2015 11AM-1PM. Please join us! This will be 1 of only 2 forums for 2015...
PROVIDER FORUM INVITATION, PIMA COUNTY - 03/13/2015
We are holding a provider forum on Tuesday, March 24, 2015 11AM-1PM. Please join us! This will be 1 of only 2 forums for 2015...
Incontinence Briefs Update - 03/06/2015
Incontinence briefs (adult diapers and pull-ups) are covered for members on AHCCCS when necessary to treat a medical condition...
PROVIDER FORUM INVITATION - 03/04/2015
We are holding a provider forum on Tuesday, March 31, 2015 11AM-1PM. Please join us!...
Dental Clinical and Billing Guidelines Update - 03/03/2015
Effective immediately, the Advantica/Care1st Clinical and Billing Guidelines have been updated...
PROVIDER FORUM INVITATION - 02/27/2015
We are holding a provider forum on Tuesday, March 31, 2015 11AM-1PM. Please join us!...
Advantica System Upgrade Notice - 02/26/2015
Our dental benefits partner, Advantica is performing a system upgrade beginning Thursday evening, February 26, 2015...
PROVIDER FORUM INVITATION - 02/26/2015
We are holding a provider forum on Tuesday, March 24, 2015 11AM-1PM. Please join us!...
PCP Fluoride Varnish Application Coding Update- 02/24/2015
Effective April 1, 2015 application of fluoride varnish by a PCP during an EPSDT visit must be billed using CPT code 99188. 99188 replaces D1206...
UPDATES TO PRIOR AUTHORIZATION GUIDELINES (Effective March 1, 2015) - 01/30/2015
The prior authorization guidelines for J-Codes have been refreshed with multiple additions and deletions...
UPDATED ONECARE PROVIDER MANUAL - 01/27/2015
The ONECare Provider Manual has recently been updated (December 2014 revision date) and is available on our website...
FORMULARY UPDATES - 01/08/2015
Formulary updates for Care1st (Acute and DDD) have recently been approved by our Pharmacy and Therapeutics Committee and are effective February 1, 2014...
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Member News
01/23/2020 - Care1st - AzCH Merger Close Message January 23, 2020 (English / Spanish)
In Arizona, Care1st Health Plan and Arizona Complete Health-Complete Care Plan are bringing our health plans together to better serve our members, providers, partners and communities.
AHCCCS covers NEMT to or from the closest appropriate AHCCCS registered provider, when a member is not able to find his/her own transportation.
08/07/2018
5/24/18 AHCCCS Complete Care: The Future of Integrated Healthcare
AHCCCS Complete Care (ACC) begins on October 1, 2018. This new integrated system will join physical and behavioral health services together to treat all aspects of our members' health care needs under a chosen health plan. AHCCCS Complete Care encourages more coordination between providers within the same network which can mean better health outcomes for members.
Here's what members need to know
Who Does AHCCCS Complete Care Affect?
- Most adults on AHCCCS *
- Most children on AHCCCS *
What's Changing
- Members will be able to access physical and behavioral healthcare services through a single ACC health plan.
- The health plan choices may change
What's Not Changing?
- Members will still have a choice of health plans in their geographic service area.
- Members will have access to the same array of covered services.
- Members will still have access to a network of providers.
- Regional Behavioral Health Authorities (RBHAs) will continue to provide specific crisis services.
- RBHAs will continue to serve members determined to have a Serious Mental Illness, children in foster care, and members served by Department of Economic Services/DDD.
- American Indian members will have the choice of enrolling in an ACC managed care plan or the American Indian Health Program (AIHP) and a Tribal RBHA when available. American Indian members will have the same access to Indian Health Services providers, Tribal 638 providers, and Urban Indian Health providers.
- Arizona Long Term Care System (ALTCS) plans will remain the same.
For more information, please visit the AHCCCS Website: AHCCCSCompleteCare
Beginning October 1, 2015, members residing in Pima County will receive behavioral health services from Cenpatico Integrated Care.
- Pima County Behavioral Health Change (English)
- Pima County Behavioral Health Change (Spanish)
General Mental Health Change for Care1st (Medicaid) Members enrolled in ONECare (Medicare)
Beginning October 1, 2015, Care1st members who are also enrolled in the Medicare Advantage plan offered by ONECare will receive General Mental Health and Substance Abuse (GMH/SA) services through Care1st instead of a Regional Behavioral Health Authority (RBHA) or Tribal Regional Behavioral Health Authority (TRBHA).
- ONECare Medicare Dual Eligible Integration (English)
- ONECare Medicare Dual Eligible Integration (Spanish)
General Mental Health Change for Care1st Members with Medicare (Other than ONECare)
Beginning October 1, 2015, Care1st members who also have Medicare Part A and B will receive General Mental Health and Substance Abuse (GMH/SA) services through Care1st instead of a Regional Behavioral Health Authority (RBHA) or Tribal Regional Behavioral Health Authority (TRBHA).
(List the Other Medicare Dual English and Spanish letters)
Behavioral Health Services Change (Maricopa County Only)
-
AHCCCS Notification to SMI Members
Starting April 1, 2014 you will be enrolled with Mercy Maricopa Integrated Care for your behavioral health and medical health care needs... -
AHCCCS Notification to American Indian SMI Members
As an American Indian you are eligible to receive your behavioral health services from a Tribal Regional Behavioral Health Authority...
Health-e-Arizona Plus
Available beginning October 1, 2013!
Health-e-Arizona Plus - Available beginning October 1, 2013!
Health-e-Arizona Plus is Arizona's online, secure application. This new-and-improved system will replace the current www.HealtheArizona.org online application, www.MyFamiliyBenefits.com and www.MyAHCCCS.com. If you currently have an account in Health-e-Arizona, you won't need to create a new account to use the new Health-e-Arizona Plus system.
Health-e-Arizona Plus is a place where you can complete your renewals or apply for help with your insurance costs for programs like AHCCCS, KidsCare, Medicare Savings Programs, Premium Tax Credit & Cost Sharing Reduction referrals to the Federal Marketplace. You can also use this new system to apply online for Nutrition Assistance and Cash Assistance.
Health-e-Arizona Plus: disponible a partir del 1 de octubre de 2013
Health-e-Arizona Plus es la aplicación segura de Internet, de Arizona. Este sistema nuevo y mejorado reemplazará a la aplicación de Internet actual www.HealtheArizona.org, y también a www.MyFamiliyBenefits.com y www.MyAHCCCS.com. Si ya tiene una cuenta en Health-e-Arizona, no tendrá que crear una cuenta nueva para usar el novedoso sistema Health-e-Arizona Plus.
En Health-e-Arizona Plus podrá hacer las renovaciones o solicitar ayuda con los costos del seguro para programas como AHCCCS, KidsCare, Programas de ahorros de Medicare, así como remisiones al Mercado Federal de Seguros Médicos para los programas de Crédito tributario para la prima y de Reducción de los costos compartidos. Puede usar este nuevo sistema para solicitar por Internet los programas de Asistencia nutricional y Asistencia en efectivo.
MEMBER EXPLANATION OF BENEFITS
The Centers for Medicare and Medicaid Services (CMS) is working on a more helpful medical explanation of benefits (EOB) for dual eligible members like you.
Beginning June 25, 2012, all applications will be considered for eligibility in the KidsCare II program. Children no longer need to be on the KidsCare waiting list. All other eligibility requirements for KidsCare II will remain the same. The Public Service Announcement below was developed by the Centers for Medicare and Medicaid Services and has more information about KidsCare II. Feel free to share the link with your networks.
- KidsCare II Public Service Announcement
(Video download may take a few moments)
As of June 4, 2012, Walgreens Pharmacies will no longer be part of the Care1st network...
English | Spanish
As of June 4, 2012, Walgreens Pharmacies will no longer be part of the Care1st network.
If you currently have a prescription being filled at a Walgreens pharmacy, you can have that prescription filled at a Care1st Network pharmacy of your choice. (i.e. Fry’s, CVS, Safeway, Walmart etc.)
- Ask the pharmacist at one of the Care1st Network Pharmacy to transfer the prescription from Walgreens, OR
- Obtain a new prescription from your doctor and take it to any of the pharmacies in Care1st Network
Care1st contracts with all other major pharmacy chains in the Valley (see list below) as well as many other community pharmacies. You may also visit our website at www.care1st.com/az and click on “Find a Doctor, Hospital, Urgent Care, Pharmacy” Or, call Member Services 602-778-1800 or 1-866-560-4042.
If you have any questions, please call Member Services at 602-778-1800 or 1-866-560-4042.
1ST CARE PHARMACY
ALBERTSONS,
APOTHECARY SHOP,
ARIZONA PHARMACY, LLC,
ARIZONA SENIOR CARE PHARMACY
AVONDALE NEIGHBORHOOD PHARMACY
BANNER FAMILY PHARMACY
BASHA’S
BUCKEYE HEALTH MART PHARMACY
CAMELBACK VILLAGE
CHANDLER FHC PHARMACY
CHC PHARMACY
CIGNA MEDICAL GROUP PHARMACIES
COMMUNITY CLINICAL PHARMACY
CVS
FAIRMONT PHARMACY
FOOD CITY, FOOTHILLS PROFESSIONAL PHARMACY
FRYS FOOD AND DRUG
GLENDALE FHC PHARMACY
HARBOR VISTA PHARMACY
HOLIDAY RX INC
KMART
MG PHARMACY
MMC OUTPATIENT DISCHARGE PHARMACY
MACK'S PHARMACY
MELROSE PHARMACY
OSCO
PHARMERICA
PHOENIX CHILDRENS HOSPITAL PHARMACY
QOL MEDS
RANCH PHARMACY
SAND G PHARMACY INC
SAFEWAY
SALIBAS SKILLED CARE PHARMACY
SAMS PHARMACY
SOUTH CENTRAL FHC PHARMACY
SUN VALLEY PHARMACY
SUNNYSLOPE FHC PHARMACY
SUNSHINE PHARMACY
SUNWEST
TARGET
WAL-MART
WEST VALLEY HEALTHMART PHARMACY
XPRESS CARE PHARMACY
A partir del 4 de junio 2012, Walgreens Pharmacies ya no sera parte de la red de Care1st.
Si usted tiene una receta médica actual en una farmacia Walgreens, pídale al farmacéutico de Walgreens que transfiera su receta a una farmacia de la red de Care1st o le puede pedir otra receta a su médico y llevarla a otra farmacia en la red de Care1st (como Fry’s, CVS, Safeway, Walmart, etc.)
Care1st contrata con la mayoría de las principales cadenas de farmacias en el valle (vea la lista abajo) y muchas otras farmacias en la comunidad. También puede visitar nuestro sitio web en www.care1st.com/az y seleccione "Find a Doctor, Hospital, Urgent Care, Pharmacy." O llame a Servicios Para Miembros al 602-778-1800 o 1-866 - 560-4042.
Si tiene preguntas, favor de llamar al Departamento de Servicios al Miembro 602-778-1800 o 1-866-560-4042.
1ST CARE PHARMACY
ALBERTSONS,
APOTHECARY SHOP,
ARIZONA PHARMACY, LLC,
ARIZONA SENIOR CARE PHARMACY
AVONDALE NEIGHBORHOOD PHARMACY
BANNER FAMILY PHARMACY
BASHA’S
BUCKEYE HEALTH MART PHARMACY
CAMELBACK VILLAGE
CHANDLER FHC PHARMACY
CHC PHARMACY
CIGNA MEDICAL GROUP PHARMACIES
COMMUNITY CLINICAL PHARMACY
CVS
FAIRMONT PHARMACY
FOOD CITY, FOOTHILLS PROFESSIONAL PHARMACY
FRYS FOOD AND DRUG
GLENDALE FHC PHARMACY
HARBOR VISTA PHARMACY
HOLIDAY RX INC
KMART
MG PHARMACY
MMC OUTPATIENT DISCHARGE PHARMACY
MACK'S PHARMACY
MELROSE PHARMACY
OSCO
PHARMERICA
PHOENIX CHILDRENS HOSPITAL PHARMACY
QOL MEDS
RANCH PHARMACY
SAND G PHARMACY INC
SAFEWAY
SALIBAS SKILLED CARE PHARMACY
SAMS PHARMACY
SOUTH CENTRAL FHC PHARMACY
SUN VALLEY PHARMACY
SUNNYSLOPE FHC PHARMACY
SUNSHINE PHARMACY
SUNWEST
TARGET
WAL-MART
WEST VALLEY HEALTHMART PHARMACY
XPRESS CARE PHARMACY
AARP and AHCCCS are working together to improve the healthcare of individuals with both AHCCCS and Medicare coverage. But we need your help...
English | Spanish
As of April 1, 2012, Care1st will only cover Blood Glucose Meters and Strips made by Abbott Diabetes Care such as FreeStyle Lite blood glucose meters and test strips. All other brands of blood glucose meters and test strips will not be covered after March 31st, 2012.
English | Spanish
As of March 1, 2012, ONECare will add Blood Glucose Meters and Strips by Abbott Diabetes Care such as FreeStyle Freedom Lite blood glucose meters and test strips. All other brands of blood glucose meters and test strips will not be covered after June 30, 2012.
English | Spanish
Non-Emergency Medical Transportation Copayments - 2/27/2012
- reside in Maricopa and Pima Counties, and
- are aged 19 and older, and
- are enrolled in an AHCCCS Health Plan
*Childless Adults (also known as AHCCCS Care) or the “TWG (Title XIX Waiver Group) Population.”]
Providers impacted by this mandatory copayment include those who provide transportation via a "taxi," which is defined as a vehicle that has been issued a taxi special license plate pursuant to A.R.S. § 28-2515.
MVD Photos Added To AHCCCS On-Line Eligibility Verification - 12/19/2011
To help protect your identity and prevent fraud, AHCCCS is adding pictures to its on-line verification tool that providers use to verify your coverage. If you have an Arizona driver's license or state issued ID, AHCCCS will get your picture from the Arizona Department of Transportation Motor Vehicle Division (MVD). When providers pull up the AHCCCS eligibility verification screen, they will see your picture (if available) with your coverage details.
Español
Para ayudar a proteger su identidad y prevenir el fraude, AHCCCS ha añadido fotos de sus miembros en el sitio web de AHCCCS que los proveedores utilizan para verificar su cobertura. Si usted tiene una licencia de conducir de Arizona o una identificación emitida por el estado, AHCCCS recibirá la imagen del Departamento de Transporte de Arizona División de Vehículos Motorizados (MVD). Cuando los proveedores busquen su verificación de elegibilidad en el sitio web de AHCCCS, verán su foto (si está disponible) con los detalles de su cobertura.
BENEFIT CHANGES - EFFECTIVE OCTOBER 1, 2011.
Due to Arizona's budget problems, some of the services that you may receive are being reduced beginning October 1, 2011...
English | Spanish
IMPORTANT NOTICE ABOUT A FREEZE ON THE AHCCCS CARE PROGRAM - EFFECTIVE JULY 2011.
Due to the current budget crisis in Arizona, the State will "freeze" new enrollment in the AHCCCS Care program beginning July 8, 2011....
English | Spanish
NOTICE ABOUT CHANGES TO THE MEDICAL EXPENSE DEDUCTION (MED) PROGRAM AND THE AHCCCS CARE PROGRAM - EFFECTIVE JULY 2011.
At this time, only the Medical Expense Deduction (MED) program and the AHCCCS Care Program have been affected.....
English | Spanish
AHCCCS has reinstated coverage for several types of transplants for members age 21 years and older - Effective date of April 1, 2011 .
To see more information about the changes in transplant coverage visit the benefit page on the AHCCCS website.
BIRTHING CENTER CLOSURE - 2/9/2011
Effective February 5, 2011 the Birthing Center at John C. Lincoln North Mountain is closed.
AHCCCS Memo - Well Exams - 10/20/2010
In response to significant fiscal challenges facing the State and growth in the Medicaid population, AHCCCS implemented several changes to the adult benefit package effective October 1, 2010...
Changes in Benefits and Co-pays!
As a result of huge budget problems facing the State and the continuing growth in the Medicaid population, effective October 1, 2010, AHCCCS will implement several changes to adult benefits and co-pays.
For more information visit the
AHCCCS website.
For the latest information on co-pays visit http://www.azahcccs.gov/members/copayments.aspx
- Notice of Acute Member Benefit Change
- Notice of ALTCS Member Benefit Change
- Notice of Changes in Your Co-pays for AHCCCS Services - (MED) programs
- Notice of Changes in Your Co-pays for AHCCCS Services - (TMA) program
- En Español:
- Aviso de Cambio en beneficios para miembros
- Aviso de Cambio en beneficios para miembros (DDD)
- Aviso de Cambios en sus Pagos Complementarios para los Servicios de AHCCCS - (MED)
- Aviso de Cambios en sus Pagos Complementarios para Servicios de AHCCCS - (TMA)
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