DCS Comprehensive Health Plan

Members Residing Out-of-State

Statement/Purpose

This policy outlines the requirements for the development, approval and distribution of member identification cards for the Department of Child Safety Comprehensive Health Plan (DCS CHP).

Definitions

834 Enrollment Transaction File: A nightly transaction file provided by AHCCCS to its Contractors. The file identifies newly-enrolled members and enrollment changes for existing members.

Business Day: A business day is considered to extend from 7:00 am in the morning to 7:00 am the following morning. If the next day is a weekend or a holiday, then the ending timeframe is extended to 7:00 am in the morning of the day following the weekend or holiday.

Member Identification Card (ID): A Contractor-specific identification card that meets the formatting requirements outlined in this Policy and issued by the Responsible Contractor to each member. The ID Card is used by the member when presenting for Medicaid services.

Mercy Care DCS CHP: The contracted Managed Care Organization (MCO)

Policy

DCS CHP, through its contracted MCO, produces and distributes member identification cards, for use by members when presenting for health care services, in compliance with Federal and State laws and regulations, and contractual requirements set forth by AHCCCS.

Procedure

Identification

DCS CHP reviews and updates an electronic transaction file submitted by AHCCCS (834 Enrollment Transaction File) to identify newly-enrolled members and enrollment changes for existing members. DCS CHP shares updated enrollment files with its contracted MCO on a timely and consistent basis. The contracted MCO utilizes the enrollment files to create and/or update member identification cards.

Format

DCS CHP’s contracted MCO is responsible for obtaining DCS CHP approval prior to the production and distribution of health plan Member ID cards.

The health plan’s member identification cards and replacement cards meet AHCCCS requirements as outlined in AHCCCS ACOM Policy 433, Attachment A, Table of Requirements and include the following information:

• Member name;

• DCS CHP Member ID number or AHCCCS ID number;

• Health plan name;

• Subcontracted health plan name;

• TTY/TDY and toll-free health plan telephone numbers;

• Statewide crisis telephone number;

• Nurse triage telephone number;

• Pharmacy benefit name/customer service telephone number;

• Disclaimer to carry the card at all times and present for services;

• Disclaimer that using the card inappropriately is a violation of the law;

• Disclaimer that the card is not a guarantee for services; and

• Notice to providers to bill DCS CHP for all charges.

Distribution

DCS CHP’s contracted MCO distributes member identification cards to all members within 12 business days from the business day following receipt of the AHCCCS 834 Enrollment Transaction File. Requests for replacement ID cards are mailed within 5 days of the request.

ID cards may also be printed by the members custodial agent utilizing the MCO web-based portal known as FamilyCare Central.

In the event the contracted MCO replaces all ID Cards with a new version, each member shall receive their new ID Card at least 14 calendar days prior to the effective date of the card.

Compliance and Oversight Monitoring

The contract between DCS and its contracted MCO defines operational performance requirements to be satisfied when providing healthcare services to members. DCS CHP conducts ongoing reviews of operational performance requirements. If it is determined that the MCO is not meeting the terms of their contract, DCS CHP notifies the MCO in writing of deficiencies. Performance Improvement Plans are forwarded to the MCO and include corrective actions and dates by which corrective actions are to be completed.