News & Events: Details
10/11/2022Learn more about the following topics: 1) AHCCCS to Start Process to Disenroll Non-Compliant Providers and 2) RSV Prophylaxis Season.
AHCCCS to Start Process to Disenroll Non-Compliant Providers
Process is expected to take 10 months
In April 2022, AHCCCS reinstated provider enrollment requirements that had been suspended during the COVID-19 public health emergency. Beginning in October, AHCCCS will start a 10-
month process of disenrolling providers who have not complied with multiple re-registration requests.
Any provider who has not completed the revalidation process in the AHCCCS Provider Enrollment Portal will receive written notification to submit an application. Providers who do not respond will receive written notification of pending disenrollment and appeal rights.
To avoid termination and/or loss of billing privileges, providers must respond and take action, following specific actions outlined in the letter, within the noted time frames. Failure to complete these actions result in disenrollment and claim denials.
What AHCCCS providers need to know:
- Providers who need to complete the revalidation process or meet additional screening requirements will be notified in writing through United States Postal Service mail.
- AHCCCS will review the submitted application and issue a written notice upon completion.
- Providers that have an expired license will be notified in writing to submit the current license or certification.
- Providers who fail to respond to the request could experience delays such as termination and/or loss of billing privileges.
If you are no longer participating as a Medicaid provider or not employed with an organizations, or if you have questions, please reach out to APEPTrainingQuestions@azahcccs.gov.
Provider Guidance: RSV Prophylaxis Season Begins Early
We would like to provide guidance to pediatricians, family medicine physicians and other providers regarding coverage of Synagis® (palivizumab) in high-risk infants for passive immunoprophylaxis against Respiratory Syncytial Virus (RSV) during the 2022-23 RSV season.RSV activity in the United States usually begins in the late fall and extends through spring; peak activity typically occurs in early February. National and regional surveillance data indicate that RSV infection rates have increased in recent weeks. In response to this trend, Banner – University Family Care (B – UFC/ACC) is issuing prior authorization requests, effective immediately for members who qualify for RSV immunoprophylaxis with Synagis. A copy of the form follows this newsbrief.
Banner – University Health Plans (B – UHP) will be using the July 2014 American Academy of Pediatrics (AAP) guidelines in making coverage determinations for RSV immunoprophylaxis as well as all guidance related to any out-of-season RSV case trends. Please submit a completed RSV form to B – UHP for all patients you plan to prescribe and/or administer Synagis before the first dose is administered for a coverage determination. Note: if you have already submitted a prior authorization request, you are not required to resubmit the request, but you may be contacted by B – UHP to submit additional clinical documentation as needed.
Synagis® (palivizumab) is covered via medical or pharmacy benefit. Submit medical claims for Synagis using standard billing practices for “buy and bill” drug products. To submit claims via the pharmacy benefit, follow the instructions below once an approved prior authorization is in place.
1. Ordering Synagis for In Office Administration
- Please use Banner Family Pharmacy – Chandler
- Contact Information: (844) 747-6442
- Please include provider’s office shipping address and best contact information for member’s legal guardians.
- Banner Family Pharmacy will verify prescription and coverage.
- Once verified, Banner Family Pharmacy will complete a welcome call with member’s legal guardians.
- After the welcome call has been completed, medication will be shipped to the provided office address.
2. Ordering Synagis for In Home Administration by Home Health Agency
- Please use CVS Specialty Pharmacy.
- Contact Information
Phone: (800) 753-2777 ext. 1037886
Fax: (800) 323-2445
- CVS will require completion of their 2022-23 Synagis Seasonal Respiratory Synctial Virus Enrollment Form.
- Contact Information
For assistance with prior authorization, coordination with Home Health or Care Management for your patient; please do not hesitate to contact us at B – UHP Customer Care Center at (800) 582-8686, TTY 711. Pediatric specialty nurse care managers are available to help with coordination of care. Please email the B – UHP Maternal and Child Care Management team at BUHPMaternalChildHealth@bannerhealth.com.