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Medicaid Secondary Billing Rules for FQHC/RHC Providers Effective June 15, 2021

Date: 05/14/21

In order to process secondary Federally Qualified Health Center (FQHC)/Rural Health Center (RHC) claims consistently and accurately, effective June 15, 2021, Arizona Complete Health-Complete Care Plan (AzCH-Complete Care Plan) will enforce the coordination of benefit rules for Medicaid as defined by Arizona Health Care Cost Containment System (AHCCCS). This process will allow claims to consistently adjudicate accurately and timely.

Coordination of Benefits (COB) should be billed as follows:

Medicare Fee for Service (FFS) is the primary payer:

  • Secondary claims are received electronically from Medicare with Medicare’s specified coding, which does not match AHCCCS’ coding requirements.
  • As a result, it is important that you resubmit the claim following the AHCCCS guidance detailed in Chapter 10 of the AHCCCS FFS Billing Manual (link below), which includes submitting on a Centers for Medicare and Medicaid Services (CMS) 1500 form, 837P professional format, American Dental Association (ADA) Form or 837D dental format as appropriate to the type of Prospective Payment System (PPS) eligible visit with the applicable place of service and the AHCCCS specified coding.
    • On the T1015 service line, report the aggregate patient responsibility and the paid and allowed amounts from the Medicare remit.
  • Include a copy of the Medicare remit.
    • The Medicare remit may not include the T1015 but all other billed services should match the services billed to AzCH-Complete Care Plan.

Allwell from AzCH (Allwell) is the primary payer:

  • Allwell creates crossover claims to process electronically under AzCH-Complete Care Plan that include Medicare’s specified coding, which doesn’t match AHCCCS’ coding requirements.\As a result, it’s important that you resubmit the claim following the AHCCCS guidance detailed in Chapter 10 of the AHCCCS FFS Billing Manual (link below), which includes submitting on a CMS 1500 form, 837P professional format, ADA Form or 837D dental format as appropriate to the type of PPS eligible visit, with the applicable place of service and the AHCCCS specified coding.
    •  On the T1015 line, report the aggregate patient responsibility and the paid and allowed amounts from the Allwell remit.
  • Include a copy of the Allwell remit.
    • The Allwell remit may not include the T1015 but all other billed services should match the services billed to AzCH-Complete Care Plan.

Other Coverage is Primary:

  • Submit the secondary claim following the AHCCCS guidance detailed in Chapter 10 of the AHCCCS FFS Billing Manual (link below), which includes submitting on a CMS 1500 form, 837P professional format, ADA Form or 837D dental format as appropriate to the type of PPS eligible visit, with the applicable place of service and the AHCCCS specified coding.
    • On the T1015 line, report the aggregate patient responsibility and the paid and allowed amounts from the primary payer’s remit.
  • Include a copy of the primary payer’s remit.
    • The primary payer’s remit may not include the T1015 but all other billed services should match the services billed to AzCH-Complete Care Plan.

AHCCCS Chapter 10 FFS Billing Manual (PDF):

ADDITIONAL INFORMATION

If you have questions regarding the information contained in this update or need your assigned Provider Engagement Specialist contact information, please email: AzCHProviderEngagement@azcompletehealth.com.