MedicaidAdministrativeMedium impact
AHCCCS DFSM Claims Clues - January 2019
Arizona Medicaid - AHCCCS·AZ · OB-GYN·Claims & Billing
Effective date
Apr 1, 2019
We identified it
Jun 17, 2026
Summary
AHCCCS announces that beginning April 1, 2019, IHS and Tribal 638 pharmacy prescriptions will run through OptumRx instead of being processed separately. The policy also updates billing procedures for Global OB codes when delivery occurs at a different facility than where prenatal/postnatal care is provided.
Action Required
By April 1, 2019: Update pharmacy billing processes for AIHP members at IHS and Tribal 638 facilities to process through OptumRx (1-855-577-6310). For Global OB billing when delivery occurs at different facility: Use POS 22 with hospital address/NPI on professional claims, contact hospital credentialing for temporary privileges to prevent claim denials.