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AHCCCS DFSM Claims Clues - May 2023 - Clarification of Billing Requirements for Behavioral Health Outpatient Claims
Arizona Medicaid - AHCCCS·AZ · Psychiatry·Claims & Billing
Effective date
May 3, 2023
We identified it
Jun 17, 2026
Summary
AHCCCS now requires comprehensive documentation (assessment, treatment plan, and medical records) for behavioral health outpatient claims when billing more than 8 units of specified codes in one day, or more than 4 units of H0034. Claims must also be billed on separate lines for each service date.
Action Required
Effective May 3, 2023: Billing team must attach comprehensive assessment, treatment plan, and medical records when submitting claims for more than 8 units of H0004, H0038, H2011, H2014, H2015, H2017, H0025, H2027, S5150, T1016, T1019 or more than 4 units of H0034 in one day. Update billing system to require separate line items for each service date - multiple dates on single claim lines are prohibited. Train staff on documentation requirements for EDI 837P, paper, and portal submissions. Failure to provide required documentation will result in claim denials.