MedicaidAdministrativeMedium impact
AHCCCS DFSM Claims Clues - February 2025
Arizona Medicaid - AHCCCS·AZ·Claims & Billing
We identified it
Jun 17, 2026
Summary
AHCCCS released February 2025 guidance for Fee-for-Service providers covering surgery prior authorization requirements, claims dispute procedures, and paper claim submission standards. Key updates include specific formatting requirements for surgery PA requests (single dates only, not date ranges) and enhanced claim denial resolution guidance.
Action Required
Immediately: Update surgery prior authorization requests to use single dates only (e.g., Service Begin Date 1/26/2025 - Service End Date 1/26/2025) instead of date ranges. Billing team must ensure paper claims use Lucinda Console font size 10, proper CMS 1500/1450 forms in red OCR ink, and include resubmission codes (Code 7 for CMS 1500, frequency code ending XX7 for UB-04). Verify all claims disputes reference active (non-void) claim numbers before submission to avoid returns.