PIMA
HEALTH 
PHS INTRODUCTION AND OVERVIEW
PROVIDER SERVICES OVERVIEW
PIMA HEALTH SYSTEM ORGANIZATIONAL CHART
PHS ADMINISTRATIVE OFFICES TELEPHONE & FAX NUMBERS
JUST THE FACTS
JUST
THE FACTS (Highlights of the Plan protocols)
JUST THE FACTS
ATTACHMENTS
PHS FORMS
REQUEST FOR PROVIDER ASSISTANCE
AUTHORIZATION REQUEST
FORM
MEDICATION REQUEST
FORM
EPSDT TRACKING/RE-ORDER FORM
ADHS/DBHS REFERRAL FOR BEHAVIORAL HEALTH SERVICES
MEMBER
RESPONSIBILITIES
MEMBER ELIGIBILITY
& ENROLLMENT
OVERVIEW
MEMBER HANDBOOKS
MEMBER ASSIGNMENT TO A
PCP
MEMBER GRIEVANCE AND REQUEST FOR HEARING
PROCESS
PROVIDER
RESPONSIBILITIES
AHCCCS
AND PHS PROVIDER
REGISTRATION
RESPONSIBILITIES OF PRIMARY CARE
PROVIDERS
RESPONSIBILITIES OF ALL
PROVIDERS
PROVIDER GRIEVANCE AND APPEALS
PROCESS
ADVANCE
DIRECTIVES
CORPORATE
COMPLIANCE
CULTURAL
COMPETENCY
COVERED SERVICES
COVERED SERVICES
OVERVIEW
PHARMACY
MANAGEMENT
BEHAVIORAL HEALTH PROGRAM OVERVIEW AND REFERRAL
PROCESS
DENTAL
SERVICES
DENTAL
SERVICES FOR CHILDREN
DENTAL
SERVICES FOR ADULTS
EXHIBIT
AHCCCS COVERED DENTAL SERVICES
MATERNAL AND CHILD HEALTH
MATERNAL CHILD HEALTH (MCH) OVERVIEW
FAMILY PLANNING SERVICES
SOBRA FAMILY PLANNING EXTENSION PROGRAM
MATERNITY CARE SERVICES
CHILDREN’S SERVICES-EPSDT PROGRAM
DENTAL SERVICES
KIDSCARE SERVICES
MCH ATTACHMENTS
UTILIZATION
MANAGEMENT/PRIOR AUTHORIZATION
MEDICAL MANAGEMENT /
UTILIZATION MANAGEMENT
OVERVIEW
PRIOR AUTHORIZATION OVERVIEW
CONCURRENT REVIEW PROCESS
RETROSPECTIVE REVIEW (MEDICAL CLAIMS REVIEW) PROCESS
GUIDELINES FOR PRIOR AUTHORIZATION
AUTHORIZATION FORM
QUALITY MANAGEMENT
QUALITY
MANAGEMENT/QUALITY IMPROVEMENT OVERVIEW
CREDENTIALING/RECREDENTIALING OF PHS PRACTIONERS
CREDENTIALING OF ORGANIZATIONAL PROVIDERS
LOCUM TENENS OVERVIEW
MEDICAL RECORDS REVIEW
CONFIDENTIALITY AND RELEASE OF MEDICAL RECORDS
SKILLED NURSING FACILITY QUALITY MANAGEMENT OVERSIGHT
REPORTING FRAUD AND ABUSE
BILLING & REIMBURSEMENT
SERVICES
BILLING
AND REIMBURSEMENT OVERVIEW
COMPLETING FORMS AND SAMPLE FORMS
- HCFA 1500 Form
- UB 92 Form
- Universal C Form
HOW TO
READ PROVIDER REMITTANCE ADVICE
CLAIMS INQUIRY
RE-SUBMITTING A CLEAN CLAIM
MEDICAL REVIEW STANDARDS FOR CLAIM PROCESSORS
COORDINATION OF BENEFITS/THIRD PARTY LIABILITY
MEDICARE SERVICES AND COST SHARING
PHS COST SHARING OVERVIEW
ELECTRONIC CLAIMS
SUBMISSION
ELECTRONIC FUND TRANSFER
PHS POLICY AND PROCEDURES
SECTION
