Are You Aware Of The Recent AHCCCS Updates?
Arizona’s Medicaid program AHCCCS planned to end contracts with two of the four MCO’s in its Long Term Care Service/Elderly and Physically Disabled program (ALTCS-EPD). Two months before the change a judge determined that the new contracts had been improperly issued, causing AHCCCS to pause the transition to the new health plans until September 30, 2025, with a final decision yet to be announced. The shift to two MCO's, likely happening next year, holds complications for home care agencies as existing Medicaid clients will be automatically enrolled to a remaining MCO while providers themselves must manually transition. Paradigm simplifies these challenges by ensuring client eligibility, automating billing, and managing payer interactions in addition to easing other Medicaid woes.
How Paradigm Helps.
Billing
Enrollments
Eligibility
EVV Support
Training
MedicaidinArizona.
Electronic Visit Verification
Upcoming changes and toss-ups to the complex web of Medicaid systems and payers can increase an already confusing scene; here we clear things up for you.
EVV Requirements
The open model Arizona uses allows providers to choose between Sandata or any EVV system of their choice.
EVV Aggregator
Sandata is Arizona’s official EVV aggregator. Any provider using a different system must ensure that it can integrate with Sandata.
EVV Billing Process
Submitting claims in Arizona varies depending on the payer. Most MCOs allow claims submission via a clearinghouse, while others require submissions through their specific online portals.
Rates
Arizona has some of the most appealing Medicaid rates in the country, with attendant care ranging from $26 to $35 per hour. In addition, there is a high volume of authorized hours per client.
It is important to note that MCO’s in Arizona tend to contract for 80% of the state rate. Therefore, it is vital to meticulously review every payer contract to ensure favorable rates. While the member transition to the newly contracted AHCCCS payers has been paused, providers will likely have to draft new contracts following the end of the health plan extension to September 2025.
Payers
State Direct:
The Arizona Health Care Cost Containment System (AHCCCS) authorizes and issues Medicaid for the state, ensuring comprehensive coverage for home care providers.
Managed Care Organizations (MCO’s)
MCO’s are entities that manage payments and referrals. There are 7 MCO’s under the Complete Care branch of AHCCCS. However, most home care providers contract with the branch ALTCS/EPD. ALTCS has 4 MCO'S as per the contract extension until September 2025:
- Banner University
- Mercy Care
- United Healthcare
- Arizona Complete Health-Complete Care Plan
To see the current MCO coverage of your area, click here.
Reach out to Paradigm for assistance with the upcoming changes, updates, and all things Medicaid.
Frequently asked questions.
Yes, Veterans do indeed have a choice of care providers. As it states on the VA's website: "Veterans can either choose their preferred community provider or a VA staff member can help select one. The selected community provider must be part of the VA’s network."
