SPSI's Arizona office has over 20 years of combined experience working with the state AHCCCS plan (Medicaid) and multiple RBHAs (Regional Behavioral Health Authority). When verifying coverage for patients who receive Medicaid benefits, the AHCCCS website is where we begin. Now that the entire GMHSA population has migrated to the ACC plans, our eligibility cascading function will not stop at AHCCCS, we will verify coverage at the payer indicated to ensure you are eligible to receive payment for the services you provide.
AHCCCS Complete Care plans (ACCs)
As of October 1, 2018, all AHCCCS GMHSA (General Mental Health and Substance Abuse) patients were migrated to one of seven ACC (AHCCCS Complete Care) plans. These are commercial insurance companies providing coverage to the GMHSA population and being compensated by AHCCCS.
- CENTRAL GSA (Maricopa, Gila and Pinal Counties): Banner University Family Care, Care 1st, Steward Health Choice Arizona, Arizona Complete Health, Magellan Complete Care, Mercy Care, UnitedHealthcare Community Plan
- NORTH GSA (Apache, Coconino, Mohave, Navajo and Yavapai Counties): Care 1st and Steward Health Choice Arizona
- SOUTH GSA (Cochise, Graham, Greenlee, La Paz, Pima, Santa Cruz and Yuma Counties): Banner University Family Care, Arizona Complete Health, UnitedHealthcare Community Plan (Pima County only)
Patients utilizing services from one of the ACC plans have the right to change their ACC plan at any time. This is one of many reasons eligibility verification is vital to maintaining an efficient revenue ccle. Claims sent to a patient's previous insurance company will be denied for inactive coverage or rejected for "member not found". Once you discover the denial or rejection, you will have to find out where the patient is insured and rebill the claim, pushing the date of payment further out.
SPSI works with all seven current ACC plans and can assist you both in sending claims and registering for electronic remits.
Referred by Mercy Care?
Mercy Care, both the affiliated RBHA and the ACC plan have chosen to underwrite the cost of electronic claim submission, therefore, when submitting to either of these plans, there is no cost to your organization. SPSI has also discounted the rates for receiving electronic remittances from these two plans. The volume of claims sent to these Mercy Care plans still factor into the rate you pay for other plans, so Mercy Care claims can help push your business into a lower cost tier for submitting claims and receiving remittances.
Regional Behavioral Health Authorities (RBHAs)
The RBHA (Regional Behavioral Health Authority) is an organization selected by the state to administer certain behavioral health services to AHCCCS recipients or state sanctioned services in three Geographic Service Area (GSAs) regions. These RBHAs cover services for adults with an SMI diagnosis, crisis services, and children in foster care enrolled in the Comprehensive Medical and Dental Program (CMDP). SPSI's local representatives have over 20 years of combined experience working with the RBHAs and state AHCCCS.
- CENTRAL GSA 6 - Mercy Care (prev. MMIC)
- NORTH GSA 7 – Steward Health Choice Arizona (prev. HCIC)
- SOUTH GSA 8 - Arizona Complete Health – Complete Care Plan (prev. CIC)
Commercial Payers/Other Payers
SPSI is able to send claims and receive electronic remittances from all commercial payers, not just the RBHAs and ACC plans. We have supported clients in sending claims to insurance plans from Alaska to Delaware and everywhere in between. Our support team will work with any payer to get the conduits set up to allow you to submit your claims and receive your remittances electronically (if available from the payer).