Section R9-22-1207. General Provisions for Payment

A.      Claims submissions.

1.        A provider of behavioral health services shall submit a claim for non-emergency behavioral health services pro- vided to a member to the appropriate RBHA.

2.        A provider of behavioral health services shall submit a claim for non-inpatient emergency behavioral health ser- vices provided to a member to the appropriate RBHA.

3.        A provider of behavioral health services shall submit a claim for non-inpatient emergency behavioral health ser- vices provided to a member enrolled in a TRBHA to the Administration.

4.        A provider of behavioral health services shall submit a claim for non-emergency behavioral health services pro- vided to a member enrolled in a TRBHA to the Adminis- tration.

5.        A provider of emergency behavioral health services, that are the responsibility of ADHS/DBHS or a contractor, shall submit a claim to the entity responsible for emer- gency behavioral health services under R9-22-210.01(A).

6.        A provider shall comply with the time-frames and other payment procedures in Article 7 of this Chapter, if appli- cable, and A.R.S. § 36-2904.

7.        ADHS/DBHS or a contractor, whichever entity is respon- sible for covering behavioral health services, shall cost avoid any behavioral health service claims if it estab- lishes the existence or probable existence of first-party liability or third-party liability.

B.       Prior authorization. Payment to a provider for behavioral health services or items requiring prior authorization may be denied if a provider does not obtain prior authorization from a RBHA, ADHS/DBHS, a TRBHA, the Administration or a contractor.

Historical Note

Adopted under an exemption from A.R.S. Title 41, Ch. 6, pursuant to Laws 1992, Ch. 301, § 61, effective Novem- ber 1, 1992; received in the Office of the Secretary of State November 25, 1992 (Supp. 92-4). Amended under an exemption from A.R.S. Title 41, Ch. 6, pursuant to Laws 1995, Ch. 204, § 11, effective October 1, 1995; filed with the Secretary of State September 29, 1995 (Supp. 95-4). Section repealed; new Section adopted by final rulemaking at 6 A.A.R. 179, effective December 13,

1999 (Supp. 99-4). Amended by final rulemaking at 13

A.A.R. 836, effective May 5, 2007 (Supp. 07-1). Amended by final rulemaking at 20 A.A.R. 3098, effec-

tive January 4, 2015 (Supp. 14-4).

Arizona Health Care Cost Containment System - Administration