Arizona Complete Health - Complete Care Plan — Centene's Arizona vehicle — is the only ACC plan in every county, holds both the North and South GSA ACC-RBHA contracts, and absorbed Care1st's members in 2024. Unlike the plans that simply link AMPM 320-S, AzCH runs a genuinely distinct corporate clinical policy: CP.BH.104 "Applied Behavior Analysis" (last revised 12/24), which layers a confirmed-diagnosis expectation, a five-year evaluation-recency rule, and hour-band guidance on top of the state baseline. Knowing where the corporate policy yields to Arizona's rules is the intake skill for this plan.
Initiation under CP.BH.104 requires medical stability, a behavioral assessment completed by a BCBA (or state-law equivalent) using record review, interviews, rating scales, and direct observation, plus an FBA — descriptive, traditional, or IISCA — or a skills assessment from a named list (VB-MAPP, ABLLS-R, AFLS, PEAK, SSIS, EFL, Socially Savvy), feeding an individualized treatment plan. Continuation requires an updated behavior assessment and updated treatment plan every 6 months (or more often if state-mandated), with progress data across settings. Intensity guidance comes as bands rather than hard caps: focused ABA at 10–25 hours/week, comprehensive ABA at 30–40 hours/week of direct treatment, and supervision at 1–2 hours per 10 direct hours (2 hours required below 10 hours/week). Whether AzCH operationally requires PA on the 97151 assessment for AHCCCS members isn't published as a single rule — the plan's prior-auth page works code-by-code, so run the lookup before promising an auth-free assessment.[6][7]
CP.BH.104 asks for a confirmed ASD diagnosis (current DSM, confirmed via tools like the ADOS-2, ADI-R, or CARS-2) "or an appropriate diagnosis as otherwise specified according to state-defined ABA criteria" — and that escape clause is what reconciles the corporate policy with Arizona's no-ASD-required Medicaid rule. When the diagnosis is non-ASD, cite AMPM 320-S explicitly in the request rather than arguing the corporate criteria. Two more facts to hold: CP.BH.104's five-year evaluation-recency rule is a dx-recency gate the state policy does not impose, so check the evaluation date at intake; and the footprint is the state's largest — every county as an ACC plan, both ACC-RBHA GSAs, and the former Care1st membership (Apache, Coconino, Mohave, Navajo, Yavapai) transitioned in 2024. News reports in March 2026 (azfamily, 3/5/2026) also named Arizona Complete Health among the plans ending contracts with Action Behavior Centers and Centria, so displaced-family inbounds may carry this plan's card.[6][9]
Arizona licenses the practice: “A person who wishes to practice as a behavior analyst must be licensed pursuant to this article” (A.R.S. § 32-2091.02, Board of Psychologist Examiners), and practicing unlicensed is a class 2 misdemeanor (§ 32-2091.12). Arizona is unusual in giving out-of-state clinicians a telehealth-only route: under A.R.S. § 36-3606 a health care provider “who is not licensed in this state may provide telehealth services to a person located in this state” after registering with the board that licenses the comparable profession, holding “a current, valid and unrestricted license to practice in another state that is substantially similar,” carrying malpractice coverage that includes Arizona telehealth, and following Arizona’s scope and standard-of-care rules. Behavior analysts are licensed under Title 32, chapter 19.1, which § 36-3601 includes in the definition of “health care provider.” A registered provider may not open an Arizona office (except within a multistate group that includes an Arizona-licensed provider) or see Arizona patients in person without an Arizona license. Fewer than ten telehealth encounters a year, or care in consultation with an Arizona-licensed provider who keeps ultimate authority, is exempt from registration.[11][12][13][14][8][15][16]
AHCCCS ties ABA to the Arizona license: AMPM Policy 320-S defines a Behavior Analyst as “A person who is licensed pursuant to A.R.S §32-2091,” and A.R.S. § 32-2091.14 directs AHCCCS to recognize “a behavior analyst who is licensed pursuant to this article” as a behavioral health professional eligible for reimbursement. A § 36-3606 telehealth registration is not that license, so for AHCCCS work plan on full Arizona licensure.[11][12][13][14][8][15][16]
Federal rules make the state Medicaid enrollment rule binding on the plan: the state “must screen and enroll, and periodically revalidate, all network providers” of Medicaid managed care plans (42 CFR 438.602(b)(1)). So a BCBA in Arizona Complete Health’s network has to be enrolled with AHCCCS as well.[11][12][13][14][8][15][16]
Narrowly. Section 4.5 of the provider manual lists the services eligible for retrospective review. The one that fits ABA: “Outpatient services requiring prior authorization when an authorization is requested after initiation of, but prior to completion of, a course of a treatment when the provider asserts completion of the course of treatment is necessary to ensure continuity of care.” A request outside the listed categories gets a denial letter explaining the appeal process.[23]
Six months to file, twelve to get it clean. A.R.S. § 36-2904(G) bars AHCCCS from paying a claim “initially submitted more than six months after the date of the service for which payment is claimed or after the date that eligibility is posted, whichever date is later,” or one not submitted as a clean claim within twelve months — and the same subsection applies the identical limits to the health plans that contract with AHCCCS, so Arizona Complete Health cannot pay a claim outside those windows either. The FFS billing manual restates it: a claim first received inside six months has until twelve months from the date of service to reach clean-claim status or be adjusted, after which “AHCCCS is not liable for payment.”[17][18][5][4][19][20][21]
AzCH’s own clock is shorter. Its Medicaid provider manual (Section 8): “Claims or Encounters must be accepted as a clean claim within 120 days from the end date service or from the date of eligibility posting whichever is later, unless there is a contractual exception.” Resubmissions “must be accepted as a clean claim within 365 days from the date of provision of the covered service or eligibility posting deadline, whichever is later,” using resubmission code 7 (replace) or 8 (void) with the original claim number; after a recoupment you have 60 days from the recoupment. With other primary insurance, the claim is due within 120 days of the date of service or 120 days from the primary payer’s EOP, whichever is later, with the primary EOB attached. Rejected claims (failed front-end edits) do not count as a timely submission.[17][18][5][4][19][20][21]
Payment. “Non-hospital claims for both participating and non-participating providers must be processed within 45 calendar days unless otherwise indicated by contract,” and AzCH commits that 95% of clean claims are adjudicated within 30 calendar days and 99% within 60; interest at 10% a year runs from the 46th day on a non-hospital clean claim. Remittances and EFT run through PaySpan; no weekly submission cutoff or check-run day is published.[17][18][5][4][19][20][21]
Disputes. AHCCCS requires claim disputes in writing within twelve months of the date of service, twelve months of the date eligibility is posted, or sixty days after the denial of a timely claim, whichever is later (A.R.S. § 36-2903.01(B)(4); A.A.C. R9-34-401 et seq.). Disputes for fee-for-service members go to AHCCCS’s Office of General Counsel (or through the AHCCCS Solutions Center); for Arizona Complete Health members the dispute is filed with Arizona Complete Health. An unfavourable Notice of Decision can be taken to a state fair hearing within 30 days of receipt.[17][18][5][4][19][20][21]
EVV. AMPM 540 (revised effective 08/06/26) applies Electronic Visit Verification to “personal care and home health services” under 42 U.S.C. 1396b(l), for ACC, DDD and fee-for-service alike, and AHCCCS’s EVV page names those services as attendant care, personal care, homemaker, habilitation, respite and in-home skilled nursing. ABA is not among them. A visit is subject to EVV only when the provider type, the service code and the place of service all match AHCCCS’s published list, so an agency that also bills habilitation in the home should check that list.[17][18][5][4][19][20][21]
The questions that decide whether a family can start with Arizona Complete Health - Complete Care Plan, and what they have to bring. Each maps onto something intake should ask on the first call.
CP.BH.104 carries no age criterion. The policy frames ASD as "typically a lifelong diagnosis... requiring treatment at any point in time," and says of Focused ABA that "it is not restricted by age, cognitive level, or co-occurring conditions." Arizona adds none either — AMPM 320-S sets no age bound.[6][8]
Five years — and it is a plan rule, not a state one. CP.BH.104 requires that "a comprehensive diagnostic evaluation, as specified according to state-defined ABA criteria, has been conducted within the past five years," including a summary of how current symptoms affect functioning across settings (family, peer, school) in communication, socialization, restricted/repetitive behaviour and adaptive functioning. AMPM 320-S imposes no recency clock, so this is the gate that catches stale evaluations on this plan.[6][8]
"ABA is recommended by a qualified licensed health care provider working within their scope of practice and who is qualified to diagnose ASD." The diagnosis itself must be "a confirmed autism spectrum disorder (ASD) diagnosis, according to the most current version of the [DSM] criteria or an appropriate diagnosis as otherwise specified according to state-defined ABA criteria" — that second clause is what lets a non-ASD Arizona diagnosis through under AMPM 320-S.[6][8]
CP.BH.104 names its instruments explicitly. The ASD diagnosis and severity level must be confirmed by one of: CHAT; M-CHAT/M-CHAT-R/F; STAT; SCQ; ASSQ; CAST; ADOS/ADOS-2; ADI-R; CARS/CARS-2; GARS-3; EarliPoint; SWYC-POSI; RITA-T; CSBS-ITC; or another evidence-based assessment reviewed case by case. The behavioral assessment then needs record review, interviews, rating scales and direct observation using continuous or discontinuous measurement, plus either an FBA (descriptive, traditional functional analysis, or IISCA) or a skills assessment from a named list — VB-MAPP, ABLLS-R, AFLS, PEAK, SSIS, EFL or Socially Savvy.[6]
No separate physician prescription is required — the recommendation from a qualified licensed health care provider qualified to diagnose ASD is the referral. What CP.BH.104 does demand up front is a completed behavioral assessment by a BCBA (or duly certified, licensed or registered equivalent under state law) feeding an individualized treatment plan, plus documented coordination of care with school, prescribers and any PT/OT/speech providers. Whether the plan requires PA on the 97151 assessment for AHCCCS members is not published as a standing rule — its prior-authorization page works code by code.[6][7]
Permitted, without a code list. CP.BH.104 states that ABA "services may be provided in various settings (e.g., home, clinic, school, community) and modalities (e.g., in-person, telehealth)," and devotes a section to CASP's Practice Parameters for Telehealth-Implementation of Applied Behavior Analysis: telehealth "is not intended to replace in person service, as it is intended to supplement the traditional in person service delivery model," with modality selected on the member's needs, preference, caregiver availability and environmental support — and "providers should refer to respective state allowances for telehealth services." Those allowances are the AHCCCS rule: AMPM 320-I binds ACC, ALTCS and DDD Contractors by its own terms. All eight ABA CPT codes (97151–97158) are on the AHCCCS Telehealth Code Set (sheet effective 06/01/2026) for interactive audio-video with the GT modifier; none carries the audio-only FQ modifier, and 0362T and 0373T are not listed. The place of service on the claim is the originating site, where the member is (12 home, 03 school, 11 office): “AHCCCS will not be utilizing POS 02 and POS 10 for telehealth” unless another primary payer requires them. AMPM 320-S requires the treatment plan to “identify the modality by which the service will be delivered (whether in person or via telehealth, or in-group or individual setting, or combination thereof),” so name telehealth in the plan you submit for authorization.[6][3][2][8]
AzCH’s provider manual (§4.3): standard requests decided "not later than fourteen (14) calendar days after the receipt of the authorization request" with a possible extension of up to 14 calendar days; expedited no later than 72 hours. Nothing ABA-specific beyond deferring to AMPM 320-S, and no reauth lead time. AHCCCS’s own CY2025 prior-authorization metrics report (March 2026) says that "Beginning January 1, 2026" the CMS rule requires Medicaid managed care plans to decide within "7 calendar days for standard requests (non-urgent)" and "72 hours for expedited requests (urgent)"; the federal regulation ties the 7-day ceiling to rating periods starting on or after January 1, 2026. AzCH’s own prior-authorization page now settles which clock it runs: “Beginning October 1, 2026 the turnaround time for Medicaid standard authorization requests will decrease from 14 to 7 calendar days” (expedited stays 72 hours) — so the manual’s 14-day clock is the rule only until then.[23][24][25][7][8]
AzCH: "The Health Plan does not require prior authorization when the Health Plan is not the primary payer." Pursue the primary and submit its EOB before billing AzCH for copays and deductibles. When the member has exhausted the primary benefit, request AzCH prior authorization for primary coverage — "The provider MUST submit evidence of the member's primary benefits being exhausted." "Medicaid is the payer of last resort except under limited situations"; AzCH pays the difference up to the contracted rate (AHCCCS allowable if non-contracted). The manual gives conflicting secondary filing windows, so file as early as possible after the primary EOB. AHCCCS policy (ACOM 434) adds pay-and-recover for preventive pediatric/EPSDT services. Under federal rules TRICARE pays before Medicaid, and CHAMPVA pays first when the child is also Medicaid-eligible.[23][5][26][27][28]
Coverage decides whether Arizona Complete Health - Complete Care Plan pays. These decide whether the claim survives: how sessions must be staffed and supervised, what may be billed concurrently, the per-day ceilings, who signs the note, where the service is payable, and whose NPI the claim goes out under.
One to two hours of supervision per ten hours of direct treatment "is considered standard of care in most cases; two hours of supervision is required if direct treatment totals less than 10 hours per week." The policy also requires "a comprehensive infrastructure for case supervision by a behavior analyst of all assessments and treatment," and documentation at both initiation and every 6-month continuation that treatment "will be delivered or supervised by an ABA-credentialed professional."[6]
No per-day unit ceiling. CP.BH.104 works in weekly bands — focused ABA 10 to 25 hours per week of direct treatment, comprehensive ABA 30 to 40 — and requires the treatment plan to outline "hours of therapy per day... with the goal of increasing or decreasing the intensity of therapy as the member/enrollee's ability to tolerate and participate permits," justified by impairment level, symptom severity, treatment history and response, and taking account of the member's age, school attendance requirements and other daily activities. At the claim level AzCH’s Medicaid manual says claims “are cycled through our editing software which is based on National Correct Coding Initiatives (NCCI),” naming the PTP code-pair edits and MUE tables; the public Medicaid MUE for 97153 is 32 units per claim line.[6][5][1]
Settings are open, with two boundaries. ABA "services may be provided in various settings (e.g., home, clinic, school, community)," and data must be "collected in multiple settings, such as in a clinic, home, and school (as applicable)." The limits: ABA is not covered for services otherwise covered under IDEA — with the express carve-back that "unless restricted within a state Medicaid benefit, ABA services can occur in coordination with school services and transition plans" — and treatment is a discontinuation candidate when "services are in lieu of school, respite care, or other community-based settings of care."[6]
Not addressed. CP.BH.104 is a medical-necessity policy; its CPT table is explicitly informational — "inclusion or exclusion of any codes does not guarantee coverage" — and it states no rule on billing 97153 and 97155 for the same clock time.[6]
Ask the plan: Centene Advanced Behavioral Health / AzCH provider services and the plan's payment policies on azcompletehealth.com.
Not published. CP.BH.104 requires an updated behavior assessment and treatment plan every six months (or more often where state-mandated) with qualitative and quantitative data gathered from providers, parents, teachers and other caregivers and collected in multiple settings, but says nothing about who signs a session note or when.[6]
Blocked on: The AzCH provider manual and your participation agreement's documentation clause.
Not addressed. CP.BH.104 requires the behavioral assessment to be completed by a BCBA "or other duly certified, licensed, or registered equivalent provider (as defined by state law)" and treatment to be delivered or supervised by an ABA-credentialed professional, but it does not say whose NPI the claim goes out under.[6]
Blocked on: AzCH provider services and the plan's billing manual; the AHCCCS credential modifiers (HM/HN/HO/HP) still govern the rate tier.
Yes — under Centene's clinical policy CP.BH.104 layered on the AHCCCS baseline: a BCBA behavioral assessment, an FBA or skills assessment, and an individualized treatment plan at initiation, with updates every 6 months.
CP.BH.104 asks for a confirmed ASD diagnosis, but its own text defers to "state-defined ABA criteria" — and Arizona's AMPM 320-S covers other diagnoses justified by medical necessity. For non-ASD cases, cite AMPM 320-S in the request.
No hard caps — CP.BH.104 uses guideline bands: 10–25 hours/week for focused ABA, 30–40 for comprehensive, with supervision at 1–2 hours per 10 direct hours.
Care1st no longer exists as a separate ACC plan — it merged into Arizona Complete Health, with northern-county members transitioned in 2024. Any "Care1st" card or listing is stale.
There is no public plan fee schedule. AHCCCS says its fixed ABA rates (effective November 1, 2023) apply only to fee-for-service programs and have “no impact on the contracts that AHCCCS health plans negotiate with their providers”: “MCOs and providers may negotiate any contracted rate that is agreed to by both parties.” Your rate is in your contract with Arizona Complete Health; the AHCCCS fee-for-service schedule does not bind the plan.
Arizona requires a license (A.R.S. § 32-2091.02) but lets an out-of-state provider deliver telehealth after registering under A.R.S. § 36-3606. AHCCCS defines a Behavior Analyst as one licensed under A.R.S. § 32-2091, so plan on an Arizona license for Medicaid work.
Only in its listed cases; for outpatient care, when the request comes after treatment started but before the course is finished and completing it is needed for continuity of care.
Six months from the date of service (or from the date eligibility is posted, if later), and twelve months to reach clean-claim status. A.R.S. § 36-2904(G) sets those outer limits for every AHCCCS plan, but AzCH’s Medicaid manual requires the claim to be accepted as clean within 120 days of the date of service unless your contract says otherwise. Resubmissions are due within 365 days; with other primary insurance, 120 days from the date of service or from the primary EOP, whichever is later.
AzCH’s manual says non-hospital claims are processed within 45 calendar days unless your contract says otherwise, with 95% of clean claims adjudicated within 30 days and 99% within 60; interest runs from day 46. Payments and remittances go through PaySpan. No weekly cutoff or check-run day is published.
Payer policies change frequently and vary by plan, state, and funding type. This guide was compiled from the sources above and last reviewed October 2026; it is general information, not billing, legal, or clinical advice. Always verify current requirements against the payer's live policy and a benefits check for the specific member.
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