The following terms and conditions apply both to services provided on a fee-for-service basis and services
provided through a Program Contractor or Health Plan:
1. Pursuant to 42 CFR 431.107, an Affiliated Provider is prohibited from participation in the Arizona Health Care
Cost Containment System unless a provider agreement with the Administration is in effect The Group Billing shall not
provide group billing services to any provider who does not have in effect a Provider Agreement with AHCCCSA at the
time services are rendered.
2. The Group Biller shall ensure that every Affiliated Provider has completed an AHCCCSA Provider Participation
Agreement, is registered with AHCCCSA, and has signed an AHCCCSA Group Billing Authorization form. Each
Affiliated Provider shall be considered part of the billing group unitl the Provider furnishes written notification of its
termination of the group billing arrangement to the AHCCCSA Provider Registration Unit.
3. The Group Biller shall include the individual Affiliate Provider’s AHCCCS Provider ID number on each claim
submitted by the Group Biller on behalf of the Affiliated Provider.
4. When AHCCCSA issues an amendment to modify this Agreement or to modify documents incorporated by
references as part of this Agreement, the provisions of such amendment will be deemed to have been accepted 30 days
after the date AHCCCSA provides notice to the Group Biller, even if the amendment has not been signed by the Group
Biller, unless within that time the Group Biller notifies AHCCCSA in writing that it refuses to sign the amendment. If
the Group Biller provides such notification, this Agreement terminates.
5. The Group Biller shall not bill, nor attempt to collect payment directly or through a collection agency from a person
claiming to be AHCCCS eligible without first receiving verification from AHCCCSA that the person was ineligible for
AHCCCS on the date of service, or that services provided were not AHCCCS covered services. The Group Biller agrees to
abide by Arizona Administrative Code R9-22-702 prohibiting the Group Biller from charging, collecting, or attempting to
collect payment from an AHCCCS eligible person.
6. The Group Biller agrees to bill the AHCCCSA only after a potential third party payer has been billed and, after
payment has been received, to bill AHCCCSA the balance due only up to the limit of the member’s responsibility.
7. In addition to other remedies available under this Agreement, AHCCCS shall be entitled to offset against any
amounts due the Group Biller any overpayments, or expenses or costs incurred by AHCCCSA concerning the Group
Biller’s non-compliance with this Agreement. The rights and remedies of AHCCCSA under this contract are not
exclusive.
8. The Group Biller shall maintain all records relating to performance of this Agreement in compliance with all
specifications for record keeping established by AHCCCSA. All books and records shall be maintained in such detail as
shall reflect each service provided and all other costs and expenses of whatever nature for which payment is made to the
Group Biller. Such material shall be subject to inspection, audit or copying by the state, AHCCCSA, the U.S. Department of
Health and Human Services, any other authorized representative of the state or federal governments during normal business
hours at the Group Biller’s place of business. The Group Biller shall preserve and make available records for a period of
five years from the date of payment under this Agreement except: (1) if this Agreement is completely or partially terminated,
the records relating to the work terminated shall be preserved and made available for a period of five years from the date of
any such termination; and (2) records which relate to disputes, litigation or the settlement of claims arising out of this
Agreement, or costs and expenses of this Agreement to which exception has been taken by the state, shall be retained by the
Group Biller until such disputes, litigation, claims or exceptions have been disposed of. The Group Biller shall comply with
all applicable AHCCCS Rules and Audit Guide relating to the audit of the Group Biller's records and the inspection of the
Group Biller's facilities.
9. The Group Biller agrees to hold harmless the state, all state officers and employees, AHCCCSA and other
appropriate state agencies, and all officers and employees of AHCCCSA against all injuries, deaths, losses, damages, claims,
suits, liabilities, judgments, costs and expenses which may, in any manner, accrue against the State, AHCCCSA or its agents,
officers or employees, or AHCCCS contractors, through any breach of contract (including, but not limited to, the Group
Billing Agreement with Affiliated Providers), intentional conduct, negligence or omission of the Group Biller, its agent,
officers or employees.
10. The Group Biller shall comply with all federal, State and local laws, rules, regulations, standards and executive
orders governing performance of duties under this Agreement, without limitation to those designated within this Agreement.
11. Confidential information shall be safeguarded pursuant to 42 CFR Part 431, Subpart F, ARS §36-107, 36-2903, 41-
1959 and 46-135, any other applicable State and Federal laws, and AHCCCS and/or ALTCS Rules.
12. Any grievances filed by the Group Biller on behalf of Affiliate Providers shall be adjudicated in accordance with
AHCCCS Rules as published in the Arizona Administrative Code. The Group Biller agrees to waive attorneys’ fees in any
disputes concerning this Agreement.
