Tribal Health Program (THP) Fee-for-Service Provider Resources

The Arizona Department of Economic Security, Division of Developmental Disabilities (DDD) provides physical and behavioral healthcare services to American Indian/Alaska Natives who qualify for the Arizona Long Term Care System (ALTCS).

Members receive services through:

• DDD Health Plan
• The Tribal Health Program (THP).

The following table shows the current health care options available for members:

*Where available.

DDD’s Tribal Health Program (THP) is a fee-for-service program. This means eligible members can get services from any Arizona Health Care Cost Containment System (AHCCCS) registered fee-for-service provider in Arizona.

American Indian and Alaska Native members may also receive physical and behavioral health services from:

• Any Indian Health Service (IHS) provider, or
• Any tribally owned or operated health facility

No prior approval is needed to receive services from these providers.

THP members may also receive:

• Long Term Services and Supports (LTSS), or
• Home and Community-Based Services (HCBS)

These services are provided by one or more DDD Qualified Vendors.

The AHCCCS Division of Fee-for-Service Management (DFSM) manages acute health services available through the DDD Tribal Health Program.

Claims Submissions

Claims for physical, behavioral, or other acute services must be submitted to AHCCCS using the AHCCCS online portal.

Fee-for-service providers can get help submitting completed claims by emailing [email protected].

Guidance for THP Claims Disputes is available:

• On the AHCCCS Provider Claims Disputes webpage, or
• In the AHCCCS Fee-for-Service Provider Billing Manual.

Providers with questions related to claims in process and/or billings:

• AHCCCS Claims Customer Service Unit
• Phoenix area: (602) 417-7670 (Option 4)
• Out of State: 1-800-523-0231, Ext. 6024177670 (Option 4)

Providers can check claim status online using the AHCCCS Online Provider Portal. Customer support for the portal is at 602-417-4451.

Providers without internet access, should call Claims Customer Service:

• 602-417- 7670 (option 4)
• 1-800-654-8713 (In State), or
• 1-800-523-0231, Ext. 6024177670 (Out of State).

Submitting Claims Online

Through the AHCCCS website, providers can submit:

• Professional claims
• Institutional claims
• Dental claims

Providers must create a username and password to log in if they do not already have one.

Qualified Vendors who provide Home and Community-Based Services (HCBS) and other Long Term Services and Supports (LTSS) must continue to submit claims to DDD using current DDD processes.

Prior Authorization Requests

Providers must request prior authorization using the Tribal Health Program Prior Authorization Request Form for:

• Physical,
• Behavioral, or
• Acute services requiring prior authorization.

More details about prior authorization and how to submit requests are available on the AHCCCS website.

For help using the AHCCCS online portal visit the DFSM Training Resources website.

AHCCCS Prior Authorization Unit (Monday - Friday 8:30 a.m. - 4:30 p.m.)

• Phoenix area: (602) 417-4400
• In State (Outside Maricopa County): 1-800-433-0425
• Out of State: 1-800-523-0231 Ext. 6024174400 (or ask for the PA area)
• Fax # (general) - (602) 256-6591
• Fax # (transportation providers only) – (602) 254-2431

Fee-for-Service providers are encouraged to sign-up to receive updates and information from the AHCCCS DFSM.

Home and Community Based Services

Support Coordinators continue to provide authorization to Qualified Vendors providing Home and Community Based Services and case management services for DDD THP members.

Frequently Asked Questions (FAQ)

THP Transition Provider FAQs