2021 Arizona Complete Health Prior Authorization Forms Updated to Include Behavioral Health Services
Date: 02/05/21
THIS UPDATE APPLIES TO THE FOLLOWING ARIZONA COMPLETE HEALTH PROVIDER TYPES: Physicians, Medical Groups/IPAs, Hospitals, Ancillary Providers, Behavioral Health Physicians
Lines of Business: Allwell (Medicare), Ambetter (Marketplace)
We communicated to you in October and December that effective January 1, 2021, Arizona Complete Health (AzCH) is administering behavioral health services for Ambetter and Allwell members (we already administered these services for our Medicaid members).
This communication is to make you aware that all of our Prior Authorization Forms are being updated to include behavioral health service types and a specific behavioral health fax number for behavioral health prior auth requests. If you are submitting a behavioral health prior auth request before the new 2021 forms are loaded, just use the version posted on our website and add the applicable Behavioral Health service type from the list below.
What You Need To Know
- Updated prior auth forms include Behavioral Health Service Type and the behavioral health prior auth request fax number
- AzCH-CCP (Medicaid), Ambetter (Marketplace), and Allwell (Medicare) have separate authorization forms. Please submit the applicable form based on the member’s health coverage so that we process your request accurately and as quickly as possible!
- Behavioral Health non-emergent inpatient prior auth requests may be faxed on the Inpatient Authorization Form to 844-918-1192
- Behavioral Health Outpatient prior auth requests may be faxed on the Outpatient Authorization Form to 844-918-1192
- The updated forms are being posted on the AzCH Prior Authorization page.
- Please include your prior auth number on your claim!
- Emergent psychiatric and emergent inpatient detox services do not require prior auth. Please submit a notice of admission within 1 day of admission and also please follow the alternative submission process.
| Line Of Business | Inpatient or Outpatient | Service Type Number | Service Type |
|---|---|---|---|
| AzCH-CCP (Medicaid) | Inpatient | 524 525 | BH Acute (includes Sub Acute) BH BHIF-RTC |
| AzCH-CCP (Medicaid) | Outpatient | 515 519 520 523 | BH Electroconvulsive Therapy BH Outpatient Therapy BH Professional Fees BH Transportation |
| Allwell (Medicare) | Inpatient | 528 529 | BH Transportation BH Psychiatric Admission |
| Allwell (Medicare) | Outpatient | 510 530 512 513 514 515 518 519 520 521 522 | BH Medical Management BH PHP BH Community Based Services BH Crisis Psychotherapy BH Day Treatment BH Electroconvulsive Therapy BH Mental Health /Chemical Dependency Observation BH Outpatient Therapy BH Professional Fees BH Psychological Testing BH Psychiatric Evaluation |
| Ambetter (Marketplace) | Inpatient | 528 529 531 532 535 536 | BH Chemical Substance Abuse BH Psychiatric Admission BH Eating Disorders BH Crisis Stabilization Unit BH Residential Treatment - Substance Use BH Residential Treatment - Mental Health |
| Ambetter (Marketplace) | Outpatient | 533 512 515 516 510 518 519 530 520 522 521 523 514 | BH Applied Behavioral Analysis BH Community Based Services BH Electroconvulsive Therapy BH Intensive Outpatient Therapy BH Medical Management BH Mental Health /Chemical Dependency Observation BH Outpatient Therapy BH PHP BH Professional Fees BH Psychiatric Evaluation BH Psychological Testing BH Transportation BH Day Treatment |
| Line of Business | Service | Prior Authorization Fax Number |
|---|---|---|
| AzCH-CCP (Medicaid) | Standard Behavioral | 855-764-8513 844-918-1192 |
| Ambetter (Marketplace) | Physical Health Transplant Behavioral | 866-597-7603 833-974-3119 844-918-1192 |
| Allwell (Medicare) | Physical Health Transplant Behavioral | 877-808-9362 866-753-5659 844-918-1192 |
Additional Ambetter and Allwell Behavioral Health Prior Auth Reminders
- Outpatient Services
AzCH is providing continuity of care to members that were in treatment during the transition. Services authorized prior to January 1, 2021, will continue for 60 days or until the authorized end date of service, whichever occurs first. - Inpatient Services
- MHN is responsible for (admit to discharge) all hospital admits that occurred prior to January 1, 2021, regardless of the date of discharge.
- For members hospitalized during the transition, AzCH is assisting with discharge planning. AzCH is responsible for all admits January 1, 2021, and forward
- Out of Home Placement (also known as Residential Treatment Centers)
- AzCH assumed responsibility as of January 1, 2021.
- AzCH is collaborating with MHN to ensure continuity of care and transition of authorizations for this level of service.
- You may use the AzCH Provider website Pre-Auth Check Tool to query specific codes to determine if a prior auth is required and, if so, use the website to submit a request for prior authorization.
- If you have specific questions for our Behavioral Health Utilization Management team regarding continuity of care transitions, please email our dedicated Service Coordinator, Michelle Strand, Michelle.Strand@azcompletehealth.com
Provider Training and Education
Additional details and provider training opportunities are available to you at any time. Please email AzchProviderEngagement@azcompletehealth.com.
Thank you for the amazing care you provide to our members!