MedicaidAdministrativeHigh impact
Reminder that Provider Participation Modifier Deadline Is January 1, 2023
Arizona Medicaid - AHCCCS·AZ·Provider News
Effective date
Jan 1, 2023
We identified it
Jun 17, 2026
Summary
Effective January 1, 2023, providers with clinic types IC (Integrated Care), 77 (Behavioral Health Outpatient), and 05 (Clinic) must report participating provider information in specific fields on all claims using designated formats with NPI numbers and provider names.
Action Required
Immediately (deadline was January 1, 2023): Billing team must update all claims for provider types IC, 77, and 05 to include participating provider information in Field 19 (CMS 1500), Field 35 (ADA forms), or 2300 NTE segment (electronic claims). Format must include XX + NPI + Provider Name (last, first, 20 characters max). Update billing software to automatically populate these fields. For school-based services, also include school identifier with 0B + 9-digit school ID. Claims without proper participating provider information may be denied.