A How to Verify BCCTP Treatment Status

Program	Manual Section
BCCTP	MA1402

Procedures

BCCTP status forms (BC-240 or BC-241) must be completed at each renewal when the customer remains within the BCCTP period of eligibility. By completing these forms, customers may re-qualify for BCCTP without a new application when they meet all of the following requirements:

Lost BCCTP eligibility within the prior 24 months;
Lost other AHCCCS eligibility because the income or resources exceeded the program limits;
Continues to meet all other eligibility criteria for BCCTP. Arizona residence and insurance coverage must be re-verified; and
Is still within a BCCTP period of eligibility.

The BCCTP Unit sends treatment verification forms to the health plan according to the following schedule:

If the diagnosis is…

The treatment verification forms are sent…

A pre-cancerous cervical lesion

3-4 months after approval and during the renewal process.

NOTE If the first verification form received does not show a treatment end date, re-verify every two months until a treatment end date is reported.

Breast or cervical cancer

Each February 1st and August 1st until a treatment end date is reported.

Complete the following steps to verify treatment status for BCCTP eligibility:

Step	Action
1	Complete the appropriate form to send to the health plan. Use the Initial Treatment Status (BC-240) form when: It is the first time you are requesting BCCTP treatment status; or You previously received a BC-240 that was missing the: Treatment begin date, Tumor size for invasive breast cancer, or Tumor staging for invasive breast cancer or invasive cervical carcinoma. Use a Treatment Status Update (BC-241) form for all other scenarios. Enter the due date in the blank field at the bottom of page one. The form must be returned within 10 calendar days.
2	Send the completed form to the appropriate health plan using the e-mail address in the Health Plan Contact Information table shown below this procedure. NOTE If any of the e-mail addresses appear to be incorrect, send a Policy Clarification Request (PCR) to report the change.
3	Was the form returned within 30 calendar days? If YES, skip to step 5. If NO, send a follow-up e-mail to the health plan requesting the status of the form. Request that the form be completed and returned within 5 calendar days. Continue to step 4.
4	Was the form returned within 5 calendar days of the follow-up e-mail? If YES, continue to step 5. If NO, STOP. Submit a Policy Clarification Request (PCR) explaining all attempts that have been made to get the form completed. Attach copies of the e-mails to the PCR submission. The Office of Eligibility Policy will evaluate the situation and determine the next steps.
5	Compare the information on the form with the information in HEAplus. Update HEAplus with any information that has changed.
6	Upload the form to HEAplus using the document type “Medical Records”.
7	Mail a copy of the completed form to the referring AZ-NBCCEDP agency: AZ-NBCCEDP Data Supervisor ADHS, Well Woman HealthCheck Program 150 North 18th Avenue, Suite 300 Phoenix, AZ 85007-3242 AZ-NBCCEDP Manager Navajo Nation PO Box 1390 Window Rock, AZ 86515 AZ-NBCCEDP Administrator The Hopi Tribe PO Box 123 Kykotsmovi, AZ 86039

Health Plan	Email Address
Arizona Complete Health Complete Care Plan	AzCHIntegratedCM@azcompletehealth.com
Banner-University Family Care	AHCCCSDeliverables@bannerhealth.com
Molina Complete Care	MCCAZ_EPSDT@magellanhealth.com
Mercy Care Department of Child Safety Comprehensive Health Plan (DCS/CHP)	CCR-HospitalCensus@AETNA.com
Health Choice Arizona	hchhcacasemanagement@healthchoiceaz.com
UnitedHealthcare Community Plan	uhccpazcompliance@uhc.com and Cc:yesenia_ornelas@uhc.com
American Indian Health Program	casemanagers@azahcccs.gov