Transition from Optum to 6 Degrees Health for Clean Claim Review of High Dollar Inpatient Medicaid Claims

Date: 04/05/24

Arizona Complete Health Complete Care Plan (AzCH-CCP) is transitioning from Optum to 6 Degrees Health for our clean claim review of high dollar Medicaid inpatient claims. This transition will be seamless for our hospitals. The 6 Degrees initial claim selection will begin on May 6, 2024. Any claim referred to Optum prior to May 6, 2024, will be handled by Optum.

What to expect:
1. Certain high dollar claims will be identified for review.
2. For identified claims, your Medical Records Department will receive a request from 6 Degrees Health to provide a comprehensive itemized bill and related documentation.
3. Upon receipt of the documentation, if the 6 Degrees Health review results in a finding(s), you’ll receive a letter from them explaining the results. If there is no finding(s), the claim will be processed as billed.
4. If you do not respond to the documentation request, no additional reimbursement will be received.

Documentation may be submitted to 6 Degrees Health via secure email, fax, or paper mail and the details of these options will be included in their request. We appreciate your assistance in providing them with the information necessary to complete these reviews.

6 Degrees Health is a Business Associate as defined in 45 CFR, Section 160.103 of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and will perform its responsibilities on our behalf in full compliance with HIPAA requirements.

If you have questions, please contact your Provider Engagement Specialist. If you need your assigned Provider Engagement Specialist’s contact information, please email us at AzCHProviderEngagement@azcompletehealth.com.