Pima Health System

Disclaimer

Important Information for Providers on Service Code Limits

This notice is to inform Providers of information available on the PHS website related to CPT and HCPCS code service limits. This reference material will enable Providers to look up the maximum daily units that are reimburseable for each CPT or HCPCS code, as established by AHCCCS. To obtain this information, you may utilize the following website link: http://phs.pima.gov/CPTserviceLimit/. Or you may go to www.pimahealthsystem.org -click on Provider Assistance then on PHS Service Limits.

When using this link, a Provider can look up information by specific CPT code or by Provider Type. Once you have brought up the code you are researching, look at the column entitled “Procedure Daily Maximum” and you will find the maximum daily units that are reimburseable for that particular code.

Effective July 27, 2009 PHS will deny claims submitted with billed units in excess of the daily procedure maximums for the code in question.

If you have questions or need assistance using this website resource, you may contact your PHS Provider Representative at their direct number or at the main number of (520) 2434-8500. If you have specific questions about claims that have been processed, please call Claims Customer Service at (520) 243-8063.

Swine Flu Information

The Pima County Health Department continues to carefully monitor the cases of Swine Flu nationwide. The number of cases in the United States continues to grow and Arizona has had a confirmed case. Pima County may have cases show up in the near future and PHS wants to make sure that you are prepared for business continuity in order to assist us in the care of our members and for the health of you, your family and employees.

Here are some excellent resources with updates happening by the minute.

Pima County Health Department: www.pimahealth.org
Arizona Department of Health Services: http://www.azdhs.gov/flu/h1n1/index.htm
Center for Disease Control: www.cdc.gov/swineflu

About Pima Health System

Pima Health System (PHS) is part of Pima County Government, under the authority of the Pima County Board of Supervisors. PHS operates three main programs:

• an acute/ambulatory managed care organization in Pima County
• a long term care (LTC) managed care program in Pima County and Santa Cruz County, and
• a non-medical model of home support programs called the Community Services System in Pima County

PHS provides services directly through PHS staff and contract professionals and utilizes the services of numerous contracted independent health care providers and group practices. Ancillary services, specialty services and social services are provided through contracts with a variety of health care providers and community agencies.

OUR VISION
To improve the quality of life for the community and the people we serve through a system of health and social services.

OUR COMMITMENT
To promote prevention, wellness and maintenance of optimal health by providing and utilizing education, service and treatment.

MEDICAL SERVICES (ACUTE/AMBULATORY MANAGED CARE PLAN)
PHS is an Arizona Health Care Cost Containment System (AHCCCS) program contractor for medical services. Persons eligible for AHCCCS covered medical services may choose to receive services from PHS. AHCCCS rules and regulations establish covered services. Through utilization and quality management of resources to assure that quality, cost effective services are provided, PHS, together with its network of providers, work together to bring quality medical care to its enrolled members. These collaborations assure that quality, cost-effective services are provided.

LONG TERM CARE SERVICES
PHS is an Arizona Long Term Care System (ALTCS) program contractor for long-term care services to its enrolled members. PHS is committed in providing quality long-term care services to its enrolled members. Long-term care services include placements for members in Skilled Nursing Facilities, or Home and Community Based options such as Adult Foster Care, Assisted Living Homes, Assisted Living Centers, or in-home care provided in the enrolled member’s own home. With a network of providers, PHS provides medical services and assistance with living activities in all of these settings.

For information on how to become eligible for AHCCCS medical or long-term care services.

THE COMMUNITY SERVICES SYSTEM
PHS in partnership with Pima Council on Aging provides a home and community based services program called the Community Services System. This program assists residents of Pima County who are frail elderly and younger disabled adults to remain safely at home for as long as possible by enhancing each individual’s quality of life and ability to remain independent. Funding for this program is through Pima County United Way, State of Arizona, City of Tucson, Pima Council on Aging, and Social Services Block Grants.

PHS DIVISIONS
To serve its enrolled member, PHS is organized into several divisions including those providing health care management, long term care program services, services to members and providers. While the divisions have their own unique functions, each work in collaboration with each other to carry out the mission of PHS.

Additionally, PHS has two other departments that provide services to individuals and families who are not part of the AHCCCS/ALTCS programs. These are the Community Services System and the Caregiver Support Program.

Our main business office location:
Herbert K Abrams Public Health Center
3950 S. Country Club Road, Suite 400
Tucson, AZ 85714
(PHS runs the majority of its business from this office in Tucson)

PHS’ Santa Cruz County office location
857 W. Bell Rd., Suite #5,
Nogales, AZ 85621

Regular business hours:
8:00 A.M. to 5:00 P.M.., Monday through Friday.

Member Services Department in Tucson hours:
8:00 A.M. to 5:00 P.M., Monday through Frida

You can reach a Member Services associate in Tucson at:
(520) 243-8060 or 1-800-423-3801

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