• Arizona Health Care Cost Containment System (AHCCCS) 

Role: Administers the Medicaid program and manages the APEP portal.

• DES Division of Developmental Disabilities (DDD) 

Role: Issues HCBS certificates for providers serving the DD population.

• AHCCCS Office of Inspector General (OIG) 

Role: Conducts audits and investigations into provider fraud and compliance.

• Centers for Medicare & Medicaid Services (CMS) 

Role: Oversees the 1915(c) and 1115 waivers that fund Arizona HCBS.

3. LICENSURE AND CERTIFICATION REQUIREMENTS

Arizona does not have a specific 'PERS License' issued by the Department of Health Services (ADHS). Instead, PERS providers are classified as 'Atypical Providers' because they do not provide direct medical care as defined by federal health regulations.

Approval is granted through the AHCCCS Provider Enrollment Portal (APEP) based on the provider's ability to meet technical specifications and insurance requirements. If the provider intends to contract with DDD, they must also obtain an HCBS Certificate from the DES Office of Licensing, Certification and Regulation.

• Licensure Status: No specific ADHS medical license is required for PERS-only agencies.
• Certification: HCBS Certification is required if contracting with the DES Division of Developmental Disabilities.
• Business License: Must maintain a valid Transaction Privilege Tax (TPT) license and local business license where applicable.
• Technical Standards: Equipment must be UL (Underwriters Laboratories) approved as a health care signaling product.
• Insurance Requirement: General Liability insurance is mandatory, typically at $1 million per occurrence.

4. MEDICAID PROVIDER ENROLLMENT

All Arizona PERS providers must enroll through the AHCCCS Provider Enrollment Portal (APEP). This system replaced the manual paper-based process and serves as the single point of entry for all Medicaid providers in the state.

Because PERS is an atypical service, providers may not be required to have a National Provider Identifier (NPI) to enroll, though they must still complete the full APEP application, including disclosures of ownership and control.

• Enrollment Portal: AHCCCS Provider Enrollment Portal (APEP) used for all new applications and revalidations.
• Provider Type: Classified as an 'Atypical Provider' (Type 55 or similar depending on the specific waiver program).
• Application Fee: A federal provider enrollment fee of $750 may apply depending on the current AHCCCS risk-level designation.
• NPI Requirement: Not required for atypical providers who do not provide healthcare per 45 CFR 160.103.
• EFT Requirement: Providers must submit an Electronic Funds Transfer (EFT) form to receive payments from AHCCCS.

5. STAFFING, TRAINING AND BACKGROUND CHECKS

Staff members who enter a member's home for installation or maintenance must undergo rigorous background checks. Arizona law requires these individuals to possess a valid Level 1 Fingerprint Clearance Card issued by the Department of Public Safety (DPS).

Training must focus on the technical aspects of the equipment, emergency protocols, and member orientation. Providers are responsible for ensuring that both the member and their primary caregiver understand how to operate the device and what to expect during an emergency call.

• Background Check: Level 1 Fingerprint Clearance Card required for all staff with direct member contact.
• Technician Training: Must be qualified to install and test PERS equipment and evaluate signal strength.
• Member Orientation: Staff must train the member on device activation and the monthly testing process.
• Response Center Staff: Must be trained in emergency dispatch protocols and 24-hour monitoring operations.
• Registry Check: Providers must check the OIG Exclusion Database and the SAM.gov exclusion list for all employees.

6. DOCUMENTATION, POLICIES AND RECORDS

Providers must maintain comprehensive records for each member, including the date of installation, equipment serial numbers, and a signed acknowledgment of training. These records must be available for inspection by AHCCCS or the contracted Managed Care Organization (MCO).

A critical component of documentation is the monthly testing log. Providers are required to ensure the system is functioning correctly at least once every 30 days and must document the results of these tests in the member's file.

• Member Records: Must include the service agreement, installation date, and emergency contact list.
• Testing Logs: Documentation of monthly system tests showing successful signal transmission to the response center.
• Incident Reports: Records of all emergency activations and the subsequent response actions taken.
• Policy Manual: Must include procedures for equipment replacement, battery failure, and emergency escalation.
• Retention Period: Records must be maintained for at least six years following the date of service.

7. BILLING, RATES and CLAIMS

Billing for PERS in Arizona is typically split into two distinct codes: one for the initial installation and one for the ongoing monthly monitoring. Claims are submitted electronically through APEP or the specific MCO's provider portal.

Rates are established by AHCCCS and are generally non-negotiable for standard providers. It is essential to verify the member's eligibility through the AHCCCS Health Insurance Portability and Accountability Act (HIPAA) Eligibility Transaction System before providing services.

• HCPCS Code S5160: Used for the one-time installation and testing of the PERS equipment.
• HCPCS Code S5161: Used for the monthly monitoring service fee.
• Claim Submission: Must be submitted within the timely filing limit, usually 6 months from the date of service.
• Eligibility Verification: Must be performed monthly via the AHCCCS APEP portal or IVR system.
• Payment Method: Payments are issued via Electronic Funds Transfer (EFT) to the provider's registered bank account.

8. APPROVAL SEQUENCE AND TIMELINE

The approval process begins with the submission of the APEP application and ends with the execution of a provider agreement. The timeline can vary significantly based on the completeness of the application and the current volume of state reviews.

Once AHCCCS approves the enrollment, the provider must then contract with the individual ALTCS Managed Care Organizations (such as UnitedHealthcare, Banner University Family Care, or Mercy Care) to receive referrals and bill for services.

• APEP Submission: Initial application takes approximately 30-60 minutes to complete online.
• State Review: AHCCCS typically processes new enrollment applications within 60 to 90 days.
• MCO Contracting: Credentialing with individual health plans can take an additional 30 to 90 days.
• Site Visit: AHCCCS may conduct a pre-enrollment site visit for certain high-risk provider categories.
• Effective Date: The enrollment date is usually the date the application was submitted in a complete state.

9. COMMON DENIALS AND SURVEYS FINDINGS

Most application denials in Arizona stem from incomplete documentation or failure to respond to 'Clarification Requested' notices in the APEP portal. Providers must monitor their APEP dashboard daily during the application phase.

During post-payment audits or surveys, common findings include missing monthly test logs and expired insurance certificates. Failure to maintain a valid Fingerprint Clearance Card for all field staff is also a frequent cause for sanctions or contract termination.

• Insurance Lapses: Failure to upload a current Certificate of Insurance (COI) to the APEP portal.
• Incomplete Disclosures: Missing information regarding owners or managing employees with a 5% or greater interest.
• Testing Failures: Lack of documentation proving that the PERS unit was tested monthly.
• Background Check Gaps: Employing technicians without a valid Level 1 Fingerprint Clearance Card.
• Revalidation Failure: Missing the mandatory revalidation deadline, which occurs every 3-5 years.

10. KEY CONTACTS AND RESOURCES 

Providers should utilize the official AHCCCS resources for technical support and policy guidance. The AHCCCS Solutions Center is the primary point of contact for portal-related issues and application status updates.

For providers serving the DD population, the DES/DDD Provider Relations unit offers specific guidance on Qualified Vendor Agreements and HCBS certification requirements.

AHCCCS Provider Services

Phone (602) 417-7670 for enrollment and billing inquiries.

APEP Portal

Official website at https://www.azahcccs.gov/APEP for all enrollment activities.

AHCCCS Solutions Center

Online ticketing system for technical support at https://servicenow.azahcccs.gov/gsp

DES/DDD Office of Licensing

Contact for HCBS Certification at (602) 771-4861.

AHCCCS Virtual Assistant (AVA)

Available at chat.azahcccs.gov for real-time application status checks.