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AHCCCS DFSM Claims Clues - March 2025
Effective date
Not stated in the notice
Identified
Jun 17, 2026
Summary
A provider licensed with ADHS solely as a counseling facility may bill only from six HCPCS codes: H0001 alcohol and/or drug assessment, H0002 behavioral health screening to determine eligibility, H0004 behavioral health counseling and therapy per 15 minutes, H0023 behavioral health outreach service, H0031 mental health assessment by a non-physician, and H2011 crisis intervention service per 15 minutes. Claims for services outside those codes will be denied. Inpatient claims with an admission date equal to the discharge date are paid using the AHCCCS Outpatient Fee Schedule methodology, and a replacement claim is required for processing.
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What to do
Action · 14 steps
01Ongoing: Billing team: for a provider licensed with ADHS as a counseling facility, bill only the HCPCS codes H0001, H0002, H0004, H0023, H0031 and H2011, because claims for services outside that list will be denied.
02Billing team: before submitting behavioral health claims, review the documentation and the claim specifics together, including the CPT code, recorded start and end times, and units, because a mismatch between these can produce denial reason code MD418 Claim Mismatch Units/Code Documented.
03Billing team: when a same-day admission and discharge produces an inpatient claim that is paid at the Outpatient Fee Schedule, submit a replacement claim for processing.
04Billing team: when attaching documents through the EDI Solutions portal using the AHCCCS Claim Reference Number, enter only the first 12 digits of the CRN and leave off the service line number such as 001 or 002, because documents will not link to the claim otherwise.
05Billing team: to attach documents electronically, create a Paper Work Number (PWK) on the claim attachment tab when submitting the claim through the AHCCCS Online Provider Portal.
06The PWK uses the member ID with a capital A followed by the first date of service in MMDDYY format, and it must be entered on the EDI Solutions upload portal as an exact match.
07Claims submitted with a PWK number will process routinely.
08Billing team: using a claim reference number for attachments triggers a manual process that adds time.
09Billing team: for a pending prior authorization, make corrections on the PA Submission tab, and if the service provider NPI must change, complete the Prior Authorization Correction form and submit it through the PA attachment tool.
10For an approved prior authorization, complete the Prior Authorization Correction Form in its entirety, upload it on the Event tab with any medical documentation, because approved cases cannot be changed in the online portal.
11Billing team: when building a prior authorization, complete all three steps: start the case, complete the Event tab with the correct event type, and complete the Activity tab with the CPT/HCPCS/revenue code, any modifier, the date span and the units, because the Activity tab is the step most commonly missed.
12Follow up on pending prior authorizations regularly, because many requests remain incomplete for several months without follow-up.
13Billing team: to request a missing 835 Electronic Remittance file, submit a service desk ticket assigned to ISD Finance that includes the provider identification number (6-digit number or NPI), the payment reference number (check number), the pay date and the check amount.
14Billing team: for NCCI edit denial code L119.1, check with the billing department first.
Codes mentioned
H0001H0002H0004H0023H0031H2011
Original notice
AHCCCS DFSM Claims Clues - March 2025
azahcccs.gov · Always check the source before changing claims.
Related changes
See all Arizona Medicaid - AHCCCS changes →AHCCCS DFSM Claims Clues - Updated Correction Notice - Updated Guidance on T1016 Code Allowance fora Provider with a Counseling Facility LicenseMediumEffective May 19, 2025 · Claims & BillingAHCCCS DFSM Claims Clues - October 2018MediumEffective Oct 1, 2018 · Claims & BillingAHCCCS DFSM Claims Clues - May 2023 - Clarification of Billing Requirements for Behavioral Health Outpatient ClaimsHighEffective May 3, 2023 · Claims & BillingAHCCCS DFSM Claims Clues - May 2023 - Transaction Insight Portal for Outpatient Behavioral Health ProvidersMediumEffective May 9, 2023 · Claims & BillingBrowse every Arizona Medicaid - AHCCCS change in the policy list