MedicaidAdministrativeMedium impact
AHCCCS DFSM Claims Clues - March 2025
Arizona Medicaid - AHCCCS·AZ · Psychiatry·Claims & Billing
We identified it
Jun 17, 2026
Summary
AHCCCS updated behavioral health documentation requirements emphasizing review before claim submission to prevent denials like MD418 for CPT/time/units mismatches. Key process updates include proper PWK number formatting for attachments, void claim dispute restrictions, and EDI Solutions requiring only first 12 digits of CRN for document uploads.
Action Required
Immediately: 1) Billing staff must review all behavioral health documentation before claim submission to ensure CPT codes match recorded start/end times and units reported. 2) When uploading documents to EDI Solutions, enter only first 12 digits of AHCCCS CRN, excluding service line numbers (001, 002). 3) For PWK attachments, use exact format: member ID + date as MMDDYY. 4) Verify claim numbers are not in void status before filing disputes. Failure to follow these procedures will result in claim denials and returned disputes.