DCS Comprehensive Health Plan

Reimbursement

Statement/Purpose

This policy outlines the requirements for reimbursement to foster caregivers for medically necessary healthcare services for children in out of home care.

Definitions

[N/A]

Policy

DCS Comprehensive Health Plan’s contracted Managed Care Organization (MCO) processes payments to Arizona Health Care Cost Containment System (AHCCCS) registered and MCO contracted providers for medically necessary covered services provided to an enrolled member. This includes physical health and behavioral health care, services, supports, supplies, prescription and over-the-counter drugs, equipment and other services.

Foster caregivers should not pay for medically necessary health services for children in out of home care. Healthcare providers are prohibited from billing foster caregivers for medically necessary services rendered by the provider including co-pays.

Foster caregivers seeking medically necessary services for an enrolled member should provide the contact information as printed on the Member ID Card to a healthcare provider in advance of services. The provider is required to bill the MCO directly for medically necessary services and reviewed for reimbursement.

Foster caregivers seeking to travel with a child outside of the United States or its territories are required to purchase international or trip healthcare insurance as DCS CHP cannot reimburse healthcare providers outside of the United States.

Procedure

Requests for reimbursements and/or medical billings received by DCS CHP and addressed to a member or out of home caregiver are sent to DCS CHP’s contracted MCO.

Caregivers who receive a bill from a provider should call the healthcare provider immediately and give them the child’s insurance information and Mercy Care DCS CHP’s address:

Mercy Care

4750 S. 44th Place, Ste. 150

Phoenix, AZ 85040

www.MercyCareAZ.org

If the caregiver continues to receive bills after giving the provider the member’s healthcare information, the caregiver should call Mercy Care DCS CHP Member Services at 602-212-4983 or 1-833-711-0776 (TTY/TDD 711) for assistance.

If a caregiver has paid out of pocket for a medically necessary service, the caregiver is instructed to send the receipt (proof of payment) and details of the payment to DCS CHP, CMDPClaims@azdcs.gov email box. The requests are reviewed and responded to within 2 business days with further instructions if necessary.