MedicaidCoverageMedium impact
AHCCCS DFSM Claims Clues - April 2023
Arizona Medicaid - AHCCCS·AZ · Dentistry·Claims & Billing
Effective date
May 11, 2023
We identified it
Jun 17, 2026
Summary
AHCCCS (Arizona Medicaid) is ending COVID-19 and flu vaccination additional reimbursements for IHS/638 pharmacies and terminating Alternative Care Site flexibility for tribal facilities effective May 11, 2023. The policy also provides guidance on prior authorization requirements and claim submission processes.
Action Required
By May 11, 2023: Stop billing additional All Inclusive Rate (AIR) reimbursements for COVID-19 and influenza immunizations at IHS/638 pharmacies - these will be reimbursed at zero dollars. Discontinue use of Alternative Care Sites for IHS and tribally owned/operated 638 facilities. Update billing systems to reflect that dental services at IHS/638 facilities are unlimited for AI/AN members over 21 (no $1000 limit). Review prior authorization requests to ensure correct Event type matches diagnosis codes to avoid claim denials.