MedicaidAdministrativeMedium impact
AHCCCS DFSM Claims Clues - June 2019
Arizona Medicaid - AHCCCS·AZ · Psychiatry·Claims & Billing
Effective date
Jul 1, 2019
We identified it
Jun 17, 2026
Summary
AHCCCS published provider guidance and checklist for Fee-for-Service billing, with key changes including new retroactive coverage rules starting July 1, 2019 (limited to month of application for most members) and mandatory prior authorization for Behavioral Health Residential Facility admissions effective April 1, 2019.
Action Required
Immediately: Billing team must sign up for AHCCCS DFSM Email Notification List and Claims Clues newsletter. Set up online claim submission accounts and Transaction Insight Portal for medical documentation. Update staff training on retroactive coverage limitations - most new Medicaid members only have coverage back to first day of application month (pregnant women and children under 19 are exempt). For any Behavioral Health Residential Facilities: ensure prior authorization process is established for all AIHP and TRBHA admissions, with 5-day notification requirement for urgent admissions.