ALTCS Prior Quarter

Prior Quarter Coverage
Prior Quarter Coverage is a different time period from Prior Period Coverage and refers to the timeframe PRIOR to an individual’s month of application for AHCCCS coverage. The dates of eligibility for Prior Period Coverage and Prior Quarter Coverage do NOT overlap. Prior Quarter Coverage is limited to the 3 month time period prior to the month of application.
If a member is determined to qualify for Prior Quarter Coverage, then the AHCCCS Administration (not the Contractor) will provide reimbursement for AHCCCS covered services for up to 3 months PRIOR to the month of application, if the member received AHCCCS covered services during the Prior Quarter Coverage timeframe. Prior Quarter Coverage is limited to the 3 month time period PRIOR to the month of application for any/all of the 3 months in which all AHCCCS eligibility criteria are met and the member has received a Medicaid covered service. The date of enrollment is not a consideration under Prior Quarter Coverage. Under Prior Quarter Coverage, reimbursement of all claims (acute, ALTCS, behavioral health, pharmacy etc.) will be managed through AHCCCS Fee for Service (FFS). Contractors are NOT involved or responsible in paying Prior Quarter Coverage claims
Example:
In using the example above, the member’s effective date of eligibility is April 1st . At the time of eligibility, the member will also be evaluated to see if s/he were Medicaid eligible for the 3 months prior to April: January, February, and March. If the member received AHCCCS covered services during any of the Prior Quarter Coverage months and would have qualified for AHCCCS at the time those services were received, then AHCCCS will reimburse the provider for those services.

Author: Patricia

AZ Medicaid Planning Boutique helping, guide, advocate, consult & qualify for AZMedicaid (ALTCS) since 2008.

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