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Enrollment
In order
to match patients with an appropriate array of services, there
is an enrollment procedure that all new patients must follow.
This involves a determination of qualifying medical condition
followed by an interview to determine payment responsibility
as well as possible eligibility for state funded programs
which may offset any or all of the costs of care at Children's
Clinic. Though many patients are referred by their primary
care physician, parents can self-refer. Enrollment packets
are available on-line,
through the mail by calling 520-324-5437 or can be picked
up in person at Children's Clinics.
Medical
Qualification
Families will be asked to provide Children's Clinics with
medical information about their child's special health care
needs in order to determine medical qualification for services.
Children who are enrolled in Arizona
Heath Care Cost Containment System (AHCCCS) must have
a clearly documented qualifying diagnosis in order to qualify.
For patients who are not enrolled in AHCCCS, Children's Clinics
may evaluate the patient to establish the qualifying diagnosis.
If you have any questions regarding medical qualification,
contact Medical Eligibility at 520-324-3471.
Payment
Responsibility
Once the qualifying medical condition has been established,
an initial payment responsibility interview is necessary.
Interviews can be scheduled via telephone or mail, but walk-ins
are welcome. An update of this information will be required
in intervals ranging from one month to one year, depending
on the insurance program that the child is covered under.
If the
patient is enrolled in AHCCCS, all that is needed is:
- the
patient's AHCCCS number or patient AHCCCS ID card
- some
form of identification for the parent or guardian, guardianship
papers, proof of residence, social security number, and
age verification (birth certificate or other proof of age).
If you have private medical insurance card, please bring
that card too.
For those
not enrolled in AHCCCS, the following information and verification,
for each member of your immediate family, may be needed to
complete the payment responsibility determination:
- Identification
for parent or legal guardian: such as driver's license,
state ID card
- Citizenship
or Alien Status Documents: such as birth certificate, passport,
certificate of citizenship, certificate of naturalization,
alien registration receipt care, temporary resident card
- Proof
of Residency: mortgage payment stub, utility bill or statement
from landlord, including the landlord's name, address, and
telephone number
- Guardianship
Papers: court documents
- Social
Security Numbers for parents and children
- Health
Insurance: insurance card; name and address or insurance
provider; and prior authorization form, if this is a requirement
of the insurance company
- Earnings,
if employed: last two months pay stubs, statement from employer,
W-2 forms
- Earnings,
if self-employed: such as Federal Income Tax return with
Schedule C and date and signature; or last 3 months monthly
ledgers of income and business expenses, income statements
or verification of income and business expenses.
- Unearned
Income and Child Support: such as check stubs, court orders,
award letters from Social Security
- Medical
Expenses: paid receipts for any medical and dental expenses,
including prescription drugs, incurred by any member of
the household income group in the past 12 months AND unpaid
bills, payment contracts, correspondences from collection
agencies.
- Child
Care: paid receipts and any outstanding bills
You may
be asked at the interview to provide additional information.
Patients covered by other insurance programs may still be
found eligible for benfits under the CRS program and this
can only be determined through the financial screening process.
If you have questions regarding payment responsibility, contact
the Enrollment Office at 520-324-3360.
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