MedicaidPrior AuthHigh impact
AHCCCS DFSM Claims Clues - February 2019
Arizona Medicaid - AHCCCS·AZ · Psychiatry·Claims & Billing
Effective date
Apr 1, 2019
We identified it
Jun 17, 2026
Summary
AHCCCS is implementing new prior authorization requirements for Behavioral Health Residential Facilities (BHRF) effective April 1, 2019, requiring authorization for all admissions and continued stays for AIHP and TRBHA members. Additionally, guidance on behavioral health services is being reorganized across multiple policy manuals, and copay rules for dual Medicare-Medicaid members have been clarified.
Action Required
By March 31, 2019: Billing team must implement prior authorization workflow for all BHRF admissions for AIHP and TRBHA members (Provider Type B8). Update billing system to require authorization before admitting patients to behavioral health residential facilities. For existing BHRF patients, facilities must submit authorization requests by May 31, 2019 for continued stay approval. Review new AMPM Policy 320-V for admission criteria and monitor AHCCCS FFS web page for authorization submission procedures and training opportunities.