Member And Provider Services
The Division of Member and Provider Services (DMPS) helps people access health care by determining Medicaid eligibility and supporting both members and providers throughout their AHCCCS journey. Their mission is to ensure timely and accurate eligibility decisions and enrollment.
Key Responsibilities:
- Medicaid Eligibility Determination for programs including:
- Long Term Care (ALTCS)
- Freedom to Work
- Aged, Blind, and Disabled
- Medicare Savings Program
- Breast & Cervical Cancer Treatment Program
- KidsCare (CHIP)
- Coordination with DES for Title XIX and XXI eligibility and oversight of the Intergovernmental Agreement (IGA).
- HEAplus System Management:
- Contract oversight
- Technical support
- System updates and testing
- Policy & Training:
- Develops eligibility policies and procedures
- Conducts CMS-required reviews and audits
- Provides training for Medicaid programs
- Member & Provider Support:
- Operates call centers for members, providers, and stakeholders
- Handles appeals and client advocacy
- Manages enrollment for Children’s Rehabilitative Services (CRS)
- Provider Enrollment & Maintenance:
- Processes provider registrations
- Maintains and revalidates over 100,000 active Medicaid providers
- Division Support Team:
- Provides administrative, reporting, purchasing, translation, and mail support
- Coordinates activities across six statewide ALTCS offices
- Oversees division budget and talent management
- Leads AMS and project management efforts