AHCCCS: Arizona Health Care Cost Containment System
ALTCS: Arizona Long Term Care System
AzEIP: Arizona Early Intervention Program
CRS: Children Rehabilitative Services
DDD: Division of Developmental Disabilities
DES: Department of Economic Security
EPSDT: Early and Periodic Screening, Diagnosis, and Treatment
HIPAA: Health Insurance Portability and Accountability Act
NARBHA: Northern Arizona Regional Behavioral Health Authority
PCP: Primary Care Provider
PPC: Prior Period Coverage – member was or is in a transitional period with regard to coverage while AHCCCS completes the enrollment process
QMB: Qualified Medicare Beneficiary
RBHA: Regional Behavioral Health Authority
SOBRA: Sixth Omnibus Budget Health Authority
WIC: Women, Infants, and Children (nutritional program)

Appeal – A formal complaint made where a member is not satisfied with a decision made by our plan.
Behavioral Health Crisis – A situation where, without immediate help, you might hurt yourself or someone else.
Behavioral Health Services – Behavioral health services may include behavior management, group, family and individual therapy and counseling, and emergency/crisis services.
Co-payment – A small charge or fee due at the time covered services are provided.
Emergency – A situation where a person’s health, or the health of an unborn baby, could be threatened. Medical help is needed right away.
Grievance – A member’s expression of dissatisfaction with any part of their care. A grievance can be filed over the phone or in writing.
Health care Power of Attorney – Someone to whom you have given the authority to make health care decisions for you if you cannot make them (usually a close friend, relative or spouse).
High-risk pregnancy – A pregnancy for which the mother or baby may be at higher risk for illness or death.
Living Will – A document where you write what you want done with your health care. The doctor uses this if you are not able to express what you want. It lists specific treatments you do or do not want. It can also tell your doctor whether or not to make special efforts to save your life.
Mammogram – Screening exam for breast cancer. Recommended for women over the age of 35.
Managed Care – A health plan that works like an HMO. Covered services are provided by providers who contract with the health plan.
Maternity care – Includes medically necessary pregnancy counseling, pregnancy testing, prenatal care, labor and delivery services, as well as care after delivery.
Maternity care coordination – Coordination of the mother’s needs to ensure she and her baby receive all the necessary care for a healthy pregnancy and delivery.
Medical Necessity – This term refers to the need for health care services or products that a doctor would give to a patient to prevent, diagnose, or treat an illness, injury, disease or its symptoms in a way that follows generally accepted standards for medicine and is not just for the convenience of the patient, physician or other health care provider.
Member – An eligible person enrolled in Blue Cross Blue Shield of Arizona Health Choice.
Personal Health Information (PHI) – PHI includes information about a member’s health care, such as physical and mental health, as well as payments for health care.
Postpartum care – Health care provided to the mother for up to 60 days after delivery.
Practitioner – Generally, refers to a certified nurse practitioner, midwife, or physician assistant.
Prenatal care – Health care provided during the pregnancy.
Prescription – A doctor’s written instructions for medication or treatment.
Primary Care Physician (PCP) – The doctor who treats the member directly. PCPs are usually family practitioners, internists or pediatricians.
Prior Authorization – Some medical procedures, surgeries, equipment and services require your primary care physician or specialist to contact us prior to determining if this service is appropriate for your care.
Provider – A person or facility that provides health care services and treatment such as a doctor, pharmacy, dentist, clinic or hospital.
Referral – Your primary care physician (PCP) may be required to you or your family member a referral for certain specialists or procedures. The referral can take the form of a document that you must bring to the specialist or facility that your PCP has referred you to. The referral tells the specialist or facility that you have seen the PCP for your condition and that additional health care services may be recommended. The referral also tells us that your PCP has referred you to a specialist or facility in our network.
Seriously and Persistently Mentally Ill (SPMI) – Any person who, as a result of a serious mental disorder, has emotions or behaviors that prevent them from performing everyday activities.
Special Health Care Needs – Patients who have serious and chronic physical, developmental or behavioral conditions who require a special type or amount of care.
Specialist – Any doctor who has special training for a specific condition or illness.
Urgent Care – Care provided to patients when their condition is not life threatening, but cannot wait until the next business day for treatment.
Women, Infants and Children (WIC) – A community program that provides food, nutrition counseling and access to health services to low income women, infants and children.