ADHS/OCSHCN/CRSA 
Policy and Procedures Manual

Table of Contents

Business Continuity
BC 1.1 CRSA Business Continuity and Recovery Plan Specific Disruptions & Staff Roles [1.2 MB PDF]
BC 1.2 CRS Contractors Business Continuity & Recovery Plan Monitoring [269K PDF]
BC 1.3 CRSA Business Continuity & Recovery Plan Contents, Annual Review, Training, & Testing [733K PDF]

Financial Management
FM 1.1 CRS Contractor Annual Financial Statement Review [469K PDF]
FM 1.2 CRS Contractor Quarterly Financial Statement Review [562K PDF]
FM 1.3 Submission of Encounters to AHCCCS [423K PDF]
FM 1.4 Submission of Encounters to CRSA [478K PDF]

General Administration
GA 1.1 CRSA Annual Administrative Review Process [2.4MB PDF]
GA 1.2 CRSA Corrective Action Plans [412K PDF]
GA 1.3 CRSA Notification Procedure for AHCCCS Medical Policy Manual & AHCCCS Contractor Operations Manual Updates [310K PDF]
GA 1.4 CRSA Document Development, Maintenance, & Dissemination [910K PDF]
GA 1.5 Language Assistance Services for CRSA & CRS Regional Contractors [513K PDF]
GA 1.6 Review & Monitoring of CRS Contractor New Member Orientation Packets [605K PDF]
GA 1.7 CRSA Corporate Compliance Program [1.4MB PDF]
GA 1.8 CRSA Cultural Competence Training & Education Program [585K PDF]

Grievance System
GS 1.1 Non-Quality of Care Grievance Process [1.6MB PDF]
GS 1.2 RESERVED
GS 1.3 Claim Dispute Process Oversight [1.01MB PDF]

HIPAA
HI 1.1 CRSA HIPAA Request to Inspect Copy Designated Record Set [17.1MB PDF]
HI 1.2 CRSA HIPAA Request to Amend Designated Record Set [13.7MB PDF]
HI 1.3 CRSA HIPAA Request for Restrictions of Uses & Disclosures [13.4MB PDF]
HI 1.4 CRSA HIPAA Request for Confidential Communications [11.8MB PDF]
HI 1.5 CRSA HIPAA Request for an Accounting of Disclosures [7.01MB PDF]
HI 1.6 CRSA HIPAA Complaint Resolution Policy [8.4MB PDF]
HI 1.7 HIPAA Notice of Privacy Practices [7.3MB PDF]


Medical Management/Utilization Management
MM/UM 1.1 Detection of Over- & Under- Utilization of Services [391K PDF]
MM/UM 1.2 CRS Contractor’s Encounters Review [388K PDF]
MM/UM 1.3 Drug Utilization Review [312K PDF]
MM/UM 1.4 Monitoring Durable Medical Equipment [465K PDF]
MM/UM 1.5 Prior Authorization Review [1.2MB PDF]
MM/UM 1.6 Concurrent Review [722K PDF]
MM/UM 1.7 Inter-Rater Reliability Testing [399K PDF]
MM/UM 1.8 Material Changes in the Provider Network [501K PDF]
MM/UM 1.9 CRSA New Medical Technology Coverage [706K PDF]
MM/UM 1.10 CRSA Clinical Practice Guideline Review [414K PDF]

Quality Management
QM 1.1 CRSA Peer Review Process [2.08MB PDF]
QM 1.2 Performance Improvement Projects (PIPs) [1.18MB PDF]
QM 1.3 Performance Measures [449K PDF]
QM 1.4 Credentialing/Re-credentialing [1.3MB PDF]
QM 1.5 CRSA Quality of Care Process [1.96MB PDF]
QM_1.6_Data_Validation.pdf effective 7/1/08 [13K PDF]


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