Articles of Importance to Read: Maternal/Newborn Case Management... 1 How to Join the APIPA Provider Network... 3 Reminder for Members Requiring

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1 Articles of Importance to Read: Maternal/Newborn Case Management How to Join the APIPA Provider Network Reminder for Members Requiring Wheelchair Assistance Help Promote Healthy Pregnancies and Newborns in Arizona Asthma Action Plans VFC Vaccine Returns Announcing an APIPA Process Change New Online Behavioral Health Resources Tips for Preventing Colon Cancer A1c Testing Urgent Care Centers Modifier Order Matters Dental Extractions Timely Filing Clean Claims Resubmitting a Claim Claim Edits - Age/Gender Restrictions on Diagnosis Codes and Procedures Duplicate Services Members with other Insurance Coverage Prior Authorization Request Medical Record Requests Vaccines for Children Program Update Durable Medical Equipment Claims Tips for Managing Heart Disease National Standards on Culturally and Linguistically Appropriate Services (CLAS) National Provider Identifier AmeriChoice/APIPA Reimbursement Policies Urgent Care Centers Language Line Quick Reference Guide Cultural Competency

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18 Code Description ProTech Indicator 5 Codes with Descriptions Transfusion, blood or blood components Thrombolysis, cerebral, by intravenous infusion Injection procedure for radiopharmaceutical localization by non-imaging probe study, intravenous (eg, parathyroid adenoma) Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid) Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure) Modification of contact lens (separate procedure), with medical supervision of adaptation Replacement of contact lens Thrombolysis, coronary; by intravenous infusion Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for sputum induction for diagnostic purposes (eg, with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing [IPPB] device) Aerosol inhalation of pentamidine for pneumocystis carinii pneumonia treatment or prophylaxis Continuous inhalation treatment with aerosol medication for acute airway obstruction; first hour Continuous inhalation treatment with aerosol medication for acute airway obstruction; each additional hour (List separately in addition to code for primary procedure) Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device Manipulation chest wall, such as cupping, percussing, and vibration to facilitate lung function; initial demonstration and/or evaluation Manipulation chest wall, such as cupping, percussing, and vibration to facilitate lung function; subsequent Nitric oxide expired gas determination Patch or application test(s) (specify number of tests) Photo patch test(s) (specify number of tests) Photo tests Professional services for allergen immunotherapy not including provision of allergenic extracts; single injection Professional services for allergen immunotherapy not including provision of allergenic extracts; 2 or more injections

19 95990 Refilling and maintenance of implantable pump or reservoir for drug delivery, spinal (intrathecal, epidural) or brain (intraventricular); Developmental testing; limited (eg, Developmental Screening Test II, Early Language Milestone Screen), with interpretation and report Intravenous infusion, hydration; initial, 31 minutes to 1 hour Intravenous infusion, hydration; each additional hour (List separately in addition to code for primary procedure) Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each additional hour (List separately in addition to code for primary procedure) Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); additional sequential infusion, up to 1 hour (List separately in addition to code for primary procedure) Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); concurrent infusion (List separately in addition to code for primary procedure) Subcutaneous infusion for therapy or prophylaxis (specify substance or drug); initial, up to 1 hour, including pump set-up and establishment of subcutaneous infusion site(s) Subcutaneous infusion for therapy or prophylaxis (specify substance or drug); each additional hour (List separately in addition to code for primary procedure) Subcutaneous infusion for therapy or prophylaxis (specify substance or drug); additional pump set-up with establishment of new subcutaneous infusion site(s) (List separately in addition to code for primary procedure) Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intraarterial Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional sequential intravenous push of a new substance/drug (List separately in addition to code for primary procedure) Chemotherapy administration, subcutaneous or intramuscular; non-hormonal antineoplastic Chemotherapy administration, subcutaneous or intramuscular; hormonal anti-neoplastic Chemotherapy administration; intravenous, push technique, single or initial substance/drug Chemotherapy administration; intravenous, push technique, each additional substance/drug (List separately in addition to code for primary procedure) Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug

20 96415 Chemotherapy administration, intravenous infusion technique; each additional hour (List separately in addition to code for primary procedure) Chemotherapy administration, intravenous infusion technique; initiation of prolonged chemotherapy infusion (more than 8 hours), requiring use of a portable or implantable pump Chemotherapy administration, intravenous infusion technique; each additional sequential infusion (different substance/drug), up to 1 hour (List separately in addition to code for primary procedure) Chemotherapy administration, intra-arterial; push technique Chemotherapy administration, intra-arterial; infusion technique, up to 1 hour Chemotherapy administration, intra-arterial; infusion technique, each additional hour (List separately in addition to code for primary procedure) Chemotherapy administration, intra-arterial; infusion technique, initiation of prolonged infusion (more than 8 hours), requiring the use of a portable or implantable pump Refilling and maintenance of portable pump Refilling and maintenance of implantable pump or reservoir for drug delivery, systemic (eg, intravenous, intra-arterial) Irrigation of implanted venous access device for drug delivery systems Photodynamic therapy by external application of light to destroy premalignant and/or malignant lesions of the skin and adjacent mucosa (eg, lip) by activation of photosensitive drug(s), each phototherapy exposure session Actinotherapy (ultraviolet light) Whole body integumentary photography, for monitoring of high risk patients with dysplastic nevus syndrome or a history of dysplastic nevi, or patients with a personal or familial history of melanoma Photochemotherapy; tar and ultraviolet B (Goeckerman treatment) or petrolatum and ultraviolet B Photochemotherapy; psoralens and ultraviolet A (PUVA) Photochemotherapy (Goeckerman and/or PUVA) for severe photoresponsive dermatoses requiring at least 4 to 8 hours of care under direct supervision of the physician (includes application of medication and dressings) Ipecac or similar administration for individual emesis and continued observation until stomach adequately emptied of poison Hypothermia; regional Hypothermia; total body Phlebotomy, therapeutic (separate procedure) G0238 Therapeutic procedures to improve respiratory function, other than described by G0237, one-on-one, face-to-face, per 15 minutes (includes monitoring) G0239 Therapeutic procedures to improve respiratory function or increase strength or endurance of respiratory muscles, 2 or more individuals (includes monitoring)

21 Urgent Care Centers MARICOPA COUNTY AHWATUKEE CHW Urgent Care 4545 E Chandler Blvd AZ Everyday 7am-10pm AVONDALE Avondale Urgent Care Nextcare W McDowell Rd Ste D-106 AZ Good Night Pediatrics Avondale W McDowell Rd Bldg L-1238 AZ Everyday 5pm -5am CHANDLER Nextcare/Chandler 600 S Dobson Rd Ste 26 AZ Chandler Valley Urgent Care 936 W Chandler Blvd #1 AZ GILBERT Good Night Pediatrics 1452 N Higley Rd AZ Everyday 5pm -5am GLENDALE Cigna Medical Group 5891 W Eugie Ave AZ M-F 7am-12am Sat. & Sun. 9am-12am Advantage Urgent Care 5410 W. Thunderbird #101 AZ M-F 8am-4pm Sat. & Sun. 9am-4pm Nextcare/Glendale N 59th Ave Ste 101 AZ West Valley Urgent Care N. 72nd Drive #10 AZ Sat. & Sun. 10am-5pm MESA Cigna Medical Group 1840 S Stapley Dr #101 AZ M-F 7am-12am Sat. & Sun. 9am-12am Nextcare/Dana Landing 3130 E Baseline Rd Ste 105 AZ Nextcare/Power 1066 N Power Rd Ste 101 AZ Advanced Urgent Care 6553 E Baywood Ave #103 AZ Phoenix Children's Specialty And Urgent Care 5131 East Southern Ave AZ Kids (5437) M-F 5pm-11pm Sat. & Sun. 12pm-11pm Urgent Care Specialists 6553 E. Baywood Ave. Ste 103 AZ PEORIA Nextcare/Peoria N Lake Pleasant Rd Ste 102 AZ PHOENIX Cigna Medical Group 755 E McDowell Rd AZ M-F 9am-9pm Sat. & Sun. 9am-7pm Advanced Urgent Care 2301 N. 44th St AZ Nextcare/Thomas 1701 E Thomas Rd Ste A-104 AZ Advanced Urgent Care 3302 W. Thomas Rd. # 10 AZ M-F 7am-7pm Advanced Urgent Care 2423 W. Dunlap Ave. #150 AZ , Nextcare/Greenway 3229 E Greenway Rd Ste 102 AZ

22 Urgent Care Centers Advanced Urgent Care 8260 W. Indian School Rd. #1 & 2 AZ Nextcare Southwest Phx Urgent Care 5920 W McDowell Rd AZ West Valley Urgent Care 4110 N. 108th Ave., Suite 100. AZ , Sat. 10am-5pm, Closed Sun. & Holidays. Good Night Pediatrics 325 E Baseline Rd AZ Everyday 5pm -5am Desert Ridge Urgent Care N Tatum Blvd Ste 190 AZ SCOTTSDALE Nextcare/Scottsdale 7425 E Shea Blvd Ste 108 AZ Sat. & Holidays 8am-4pm SURPRISE Advantage Urgent Care Mountain View #190 AZ M-F 9am-8pm Sat. & Sun. 9am-4pm West Valley Urgent Care W. Bell Rd. #101 AZ Sat.10am-5pm Closed Sun. & Holidays TEMPE Advanced Urgent Care 1804 W. Elliot Rd. AZ Nextcare Tempe 914 N Scottsdale Road AZ PIMA COUNTY MARANA Northwest Medical Center Urgent Care 8333 N Silver Bell AZ Everyday 10am -8pm ORO VALLEY Northwest Medical Center Urgent Care N Oracle Road AZ Everyday 9am-9pm *Summer Hours: Memorial Day- Labor Day Hours 9am-7pm TUCSON Nextcare/Pinnacle Medicine, Inc 6238 E Pima St AZ Northwest Medical Center Urgent Care 2945 W Ina Road AZ Everyday 9am -9pm University Physicians Inc 2800 E Ajo Way AZ Everyday 9am-1am Urgent Care Associates 1622 N. Swann AZ M-F 9am-9pm, Sat. 9am-6pm, Closed Sun. & Holidays Urgent Care Associates 9348 E Rita Road AZ M-F 12pm-8pm Sat. 10am-4pm YUMA COUNTY YUMA Foothills Medical Walk-In Clinic S Fortuna Road AZ M-F 8am-6pm Primecare Urgent Care 2377 S 22nd Dr AZ M-F 7am-7pm Primecare Urgent Care 284 W 32nd St AZ Open 24/7 Primecare Urgent Care S Scottsdale Dr AZ Open 24/7 North Side Medical Clinic/Walk- In 1394 W 16th St AZ , Sat. 8am-4pm, Closed Sun. & Holidays. page 22 Provider Service Center:

23 Language Line Quick Reference Guide Keep this Quick Reference Guide (QRG) nearby for easy reference to effectively utilize Language Line Over-the-phone Interpretation Service. When Receiving a Call: 1) Use Conference Hold to place the limited English speaker on hold. 2) Dial: ) Enter on your telephone keypad or provide the representative: 6-digit Client ID: Press 1 for Spanish Press 2 for all other languages and speak the name of the language you need at the prompt. Enter Personal Code followed by # An Interpreter will be connected to the call. 4) Brief the Interpreter. Summarize what you wish to accomplish and give any special instructions. 5) ADD THE limited-english SPEAKER to the line. 6) Say End of Call to the Interpreter when the call is completed. NOTE: When placing a call to a limited-english speaker, begin at Step 2. If you need assistance placing a call to a limited-english speaker, please inform the interpreter at the beginning of the call. Important Tips: Unknown Language If you do not know which language to request, our representative will help you. Line Quality Problems If you have problems before reaching a representative, press 0 to be transferred. If there is a sound quality problem, ask the representative to stay on the line to check for sound quality. If you have problems connecting to an Interpreter call Customer Service at Working with an Interpreter Give the Interpreter specific questions to relay. Group your thoughts or questions to help conversation flow quickly. Length of Call Expect interpreted comments to run a bit longer than English phrases. Interpreters convey meaning-for-meaning, not word-for-word. Concepts familiar to English speakers often require explanation or elaboration in other languages and cultures. Interpreter Identification Our Interpreters identify themselves by first name and number only. For reasons of confidentiality, they do not divulge either their full names or phone number. Demonstration Line To hear a recorded demonstration of over-the-phone interpretation call our demonstration line at or visit our website at Document Translation We also provide written translation services, for more information please contact our Document Translation Department at or translation@languageline.com. Customer Service To provide feedback, commend an Interpreter, or report any service concerns, call Customer Service at Language Line Services 1 Lower Ragsdale Drive, Bldg. 2 Monterey, CA Language Line Services Confidential Information

24 PRSRT STD U S POSTAGE PAID PHOENIX, AZ PERMIT NO North Third Avenue Phoenix, AZ Cultural Competency We encourage our medical professionals and their staff to review the Culturally Competent Patient Care Guide. It is a comprehensive pocket guide that discusses health beliefs and strategies and approaches for accessing patient beliefs about health and illness. For this and more information please visit our web site at