DEFINITIONS PERTAINING TO ALL AHCCCS CONTRACTS Sample Clauses

DEFINITIONS PERTAINING TO ALL AHCCCS CONTRACTS. The definitions specified in Part 1 below refer to terms found in all AHCCCS contracts. The definitions specified in Part 2 below refer to terms that exist in one or more contracts but do not appear in all contracts. 638 TRIBAL FACILITY A facility that is operated by an Indian Tribe and that is authorized to provide services pursuant to Public Law (P.L.) 93-638, as amended. ABUSE (OF MEMBER) Intentional infliction of physical, emotional or mental harm, caused by negligent acts or omissions, unreasonable confinement, sexual abuse or sexual assault as defined by A.R.S. §46-451 and A.R.S. §13-3623. ABUSE (BY PROVIDER) Provider practices that are inconsistent with sound fiscal, business or medical practices, and result in an unnecessary cost to the AHCCCS program, or in reimbursement for services that are not medically necessary or that fail to meet professionally recognized standards for health care. It also includes recipient practices that result in unnecessary cost to the AHCCCS program as defined by 42 CFR 455.2. ACUTE CARE SERVICES Medically necessary services as specified in Paragraph 10, Scope of Services. ADJUDICATED CLAIM A claim that has been received and processed by the Contractor which resulted in a payment or denial of payment. AHCCCS CONTRACTOR OPERATIONS MANUAL (ACOM) The ACOM provides information related to AHCCCS Contractor operations and is available on the AHCCCS website at xxx.xxxxxxxx.xxx. AHCCCS MEDICAL POLICY MANUAL (AMPM) The AMPM provides information regarding covered health care services and is available on the AHCCCS website at xxx.xxxxxxxx.xxx. AHCCCS MEMBER See “MEMBER.” AHCCCS RULES See “ARIZONA ADMINISTRATIVE CODE.” AMERICAN INDIAN HEALTH PROGRAM (AIHP) An acute care fee-for-service program administered by AHCCCS for eligible American Indians which reimburses for services provided by and through the Indian Health Service (IHS), tribal health programs operated under 638 or any other AHCCCS registered provider. AIHP was formerly known as AHCCCS IHS. AMERICANS with DISABILITIES ACT (ADA) The ADA prohibits discrimination on the basis of disability and ensures equal opportunity for persons with disabilities in employment, State and local government services, public accommodations, commercial facilities transportation, and telecommunications. Refer to the Americans with Disabilities Act of 1990, as amended, in 42 U.S.C. 126 and 47 U.S.C. 5. APPEAL RESOLUTION The written determination by the Contractor concerning an appeal. ARIZONA AD...
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DEFINITIONS PERTAINING TO ALL AHCCCS CONTRACTS. The definitions specified in Part 1 below refer to terms found in all AHCCCS contracts. The definitions specified in Part 2 below refer to terms that exist in one or more contracts but do not appear in all contracts. 638 TRIBAL FACILITY A facility that is operated by an Indian Tribe and that is authorized to provide services pursuant to Public Law (P.L.) 93-638, as amended. ABUSE (OF MEMBER) Intentional infliction of physical, emotional or mental harm, caused by negligent acts or omissions, unreasonable confinement, sexual abuse or sexual assault as defined by A.R.S. §46-451 and A.R.S. §13-3623. ABUSE (BY PROVIDER) Provider practices that are inconsistent with sound fiscal, business or medical practices, and result in an unnecessary cost to the AHCCCS program, or in reimbursement for services that are not medically necessary or that fail to meet professionally recognized standards for health care. It also includes recipient practices that result in unnecessary cost to the AHCCCS program as defined by 42 CFR 455.2. ACUTE CARE CONTRACTOR A contracted managed care organization (also known as a health plan) that provides acute care medical services to AHCCCS members who are Title XIX or Title XXI eligible, and who do not qualify for another AHCCCS program. Most behavioral health services are carved out and provided through the Arizona Department of Health Services, Division of Behavioral Health Services (ADHS/BHS). ACUTE CARE SERVICES Medically necessary services as specified in Paragraph 10, Scope of Services.
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Related to DEFINITIONS PERTAINING TO ALL AHCCCS CONTRACTS

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