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Arizona School-Based Medicaid Program Overview
Background
Role of AHCCCS
AHCCCS is Arizona's Medicaid program that was developed as a result of Title XIX of the Social Security Act. While AHCCCS also administers other state and federal health care programs, only Title XIX members are eligible for the DSC program. This handbook provides the information necessary to successfully participate in the DSC program. AHCCCS policies relating to the DSC program can be accessed on their website at http://www.ahcccs.state.az.us
Role of Public Consulting Group
PCG was awarded a contract by AHCCCS to act as a third party administrator for the DSC and MAC programs in November 2003. Our contract effective date was January 1, 2008. PCG provides a full spectrum of services under this contract including:
- Providing the necessary training required to prepare all LEAs to participate in the program.
- Processing claims through the AHCCCS system.
- Providing the Information Services (IS) system required to administer this program.
- The PCG data processing system houses the program membership, contracted providers and needed reference materials. It receives claims, processes them and forwards them to AHCCCS for final approval. Payment is then distributed to each LEA or their biller, accompanied by a remittance advice that identifies the claims paid and the amount, as well as listing any denials and the reason codes.
- Conducting periodic compliance reviews of participating LEAs. During the reviews, staff will assess all documentation related to the program, including provider records and student records. PCG works closely with all participants throughout this process to ensure compliance with all AHCCCS and CMS requirements.
These programs are administered at PCG in Phoenix, Arizona, by a staff that is dedicated to this program. LEA Account Managers are assigned to the individual LEAs and are available to answer questions, help resolve problems, modify the contracted provider list and perform other related support services.
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