Now In-Network with Select Arizona Medicaid Plans

Referral process for an adolescent with Arizona Medicaid (AHCCCS)

• The client must have established care with an outpatient behavioral health home (i.e. Devereux, Southwest Network, Bayless).
• The behavioral health home will need to complete a prior authorization form (found on the specific branch of AHCCCS’ website).
  • Revenue Code for inpatient or residential: 0124
  • Revenue Code for intensive outpatient: 0905
• Once the referral form is completed, the behavioral health home will need to submit it to the health plan along with supporting documents (PCP notes, psych evaluation within the last year, letter of recommendation, progress notes about eating issues, labs within the last three weeks, etc.).
  • The packet submitted to the insurance will also need to be faxed to Rosewood at (928) 668-0396.
  • In most cases, the health plan will reach out to Rosewood directly for the completed intake assessment for further review and confirm we have accepted the member.
• Once the prior authorization form has been submitted to the health plan, they can take up to two weeks to review and will then let us know if the prior authorization is approved, denied, or needs more information.
• If the prior authorization is approved by the insurance, Rosewood will then negotiate rates for a single case agreement with all AHCCCS branches except for Mercy Care.
• Once the single case agreement is signed by Rosewood and the health plan, the client can admit to one of our programs based on availability.