MedicaidAdministrativeHigh impact
AHCCCS DFSM Claims Clues - January 2023
Arizona Medicaid - AHCCCS·AZ·Claims & Billing
Effective date
Jan 1, 2023
We identified it
Jun 17, 2026
Summary
AHCCCS (Arizona Medicaid) has implemented several key changes effective January 1, 2023, including mandatory practitioner reporting for clinic claims, hard Electronic Visit Verification (EVV) claim edits, and elimination of dental service limits for American Indian/Alaskan Native members at IHS/638 facilities. Claims will be denied if individual practitioners are not properly reported on professional and dental service claims for integrated clinics, behavioral health outpatient clinics, and general clinics.
Action Required
By January 1, 2023: Billing team must update claim submission processes to include individual practitioner information on all professional and dental service claims for Provider Type IC (Integrated clinics), Provider Type 77 (Behavioral health outpatient clinics), and Provider Type 05 (Clinics). Refer to Exhibit 10-1 of the AHCCCS Fee-For-Service Provider Billing Manual for proper billing instructions. Ensure EVV compliance is implemented for applicable home and community-based services. Claims missing practitioner information will be denied. Contact Provider Training at ProviderTrainingFFS@azahcccs.gov for assistance or call (602) 417-7670 Option 4 for billing questions.