AHCCCS; grievance and
hearing
SB 1202 extends the time period in which a grievance for a claim under the Arizona Health Care Cost Containment System (AHCCCS) may be filed in both the acute care program area of AHCCCS as well as the Arizona long term care system.
Current law requires the director of AHCCCS to establish procedures and time frames for the intake of grievances and appeals. Presently, a grievance must be filed in writing within 60 days after the date of the adverse action, decision or policy implementation being grieved (ARS § 36-2903.01).
Statute allows health plan providers to submit clean claims for covered services within 12 months from the date of service. If a person is dissatisfied with the denial of a claim by AHCCCS or the provider, the person has 12 months from the date of service for which a payment is claimed to file a grievance (ARS § 36-2904). In the event a claim is denied just before the 12 month deadline, the complainant is unable to file a grievance because of the time frame established for filing claim grievances. SB 1202 adds a provision that allows grievances related to payment claims to be filed within 12 months from service date, 12 months after eligibility is posted or 60 days after the date of a timely claim denial, whichever is later.