General Provider Communication

Subject: Information Regarding Prior Period Coverage and Prior Quarter Coverage

Action: Please review FAQs


Dear Provider,


Please find information below related to Prior Period Coverage and the newly defined Prior Quarter Coverage that we received from AHCCCS:


- Differences between Prior Quarter Coverage and Prior Period Coverage


- Information regarding Prior Quarter Coverage:

Beginning January 1, 2014, the time period AHCCCS pays for covered services for an eligible individual will be extended to include the three months prior to the month the individual applied for AHCCCS, if the individual met AHCCCS eligibility requirements during the month in which the Medicaid covered service was provided. If the individual is determined to qualify for AHCCCS during any one or more of the three months prior to the month of application, then the individual will be determined to have "Prior Quarter Coverage" eligibility during those months. As a result, AHCCCS will pay for AHCCCS covered services provided during those months. Although the AHCCCS Program has previously been waived from including Prior Quarter Coverage as part of its Medicaid Program, AHCCCS is now required to include Prior Quarter Coverage starting January 1, 2014.


More information on Prior Quarter Coverage is available on the AHCCCS main PQ page at


Please share this information with your staff. Magellan is working to obtain more information on the kind of eligibility information providers can expect to see as well as the potential impact on claims processing flow. We will share more information as it becomes available.


In the meantime if you have questions, please contact your assigned provider relations liaison.


Thank you.

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