MedicaidAdministrativeMedium impact
AHCCCS DFSM Claims Clues - July/August 2022
Arizona Medicaid - AHCCCS·AZ · Psychiatry·Claims & Billing
Effective date
Oct 1, 2022
We identified it
Jun 17, 2026
Summary
AHCCCS (Arizona Medicaid) is implementing several changes effective October 1, 2022, including integration of American Indian members with SMI designation into AIHP, new participating provider reporting requirements for clinic claims, and updated behavioral health prior authorization processes.
Action Required
By October 1, 2022: Billing team must update CMS 1500 claims for clinic visits (provider types 05, 77, IC) to include participating provider NPI information in Field 19. Update ADA claim forms to include this information in Field 35. Verify behavioral health inpatient prior authorizations use Event type BI (not IP). Claims missing NPI information will be denied with code H482.