Plain English Breakdown
The official source material does not provide details on how much contractors must pay for laboratory services or the consequences if a noncontracting provider refuses payment under these rules.
AHCCCS Reimbursement Rules for Noncontracting Providers
This bill changes how AHCCCS contractors must pay for laboratory services from noncontracting providers and sets rules about prior authorization and retaliation.
What This Bill Does
- Requires AHCCCS contractors to reimburse noncontracting providers for laboratory services if a member was referred by a contracted provider of the contractor.
- Prohibits AHCCCS contractors from requiring prior authorization for diagnostic services.
- Stops AHCCCS contractors from taking or threatening retaliatory action against contracted providers who refer members to noncontracted providers.
Who It Names or Affects
- AHCCCS contractors
- Noncontracting providers
- Contracted providers
Terms To Know
- AHCCCS
- Arizona Health Care Cost Containment System, a program that provides health care to eligible Arizonans.
- Noncontracting provider
- A healthcare provider who does not have a contract with an AHCCCS contractor.
Limits and Unknowns
- The bill does not specify the amount of reimbursement for laboratory services.
- It is unclear what happens if a noncontracting provider refuses to be paid by the rules set in this bill.