← Back to list
AHCCCS DFSM Claims Clues - November 2018
Effective date
Not stated in the notice
Identified
Jun 17, 2026
Summary
Emergency dental services are covered for FFS members age 21 and older, limited to emergency dental services, with an annual benefit not to exceed $1,000 per member per contract year (October 1 to September 30), and unused benefits do not carry over. Use of the updated AHCCCS Daily Trip Report is required for NEMT claims, and claims submitted without the Daily Trip Report will be denied. Crisis services for AIHP members are billed to the RBHA for the first 24 hours and to AIHP after that, using hourly code S9484 and per diem code S9485.
Get alerts when payers change rules like this one
We check Arizona Medicaid - AHCCCS and other payers every day and email you when a change matches your specialty and state.
Get Arizona Medicaid - AHCCCS alertsPolicy Monitoring is free. No card required.
What to do
Action · 10 steps
01Already effective 2018-07-15: NEMT providers must use the updated AHCCCS Daily Trip Report, and only the AHCCCS approved version may be submitted.
02Providers may not create their own versions.
03AHCCCS accepts PDF files of the Daily Trip Report and does not accept HTML or Excel files, so an Excel file must be converted to PDF before submission.
04Unloaded mileage is not a covered service, and NEMT providers may not submit a claim for unloaded mileage or bill for picking up a member's prescription on the member's behalf.
05Emergency dental: it is the provider's responsibility to check with the member how much of the dental benefit has already been used within the contract year, and the benefit does not cover comprehensive services such as cleanings.
06Crisis services for AIHP members: for the first 24 hours, bill the RBHA, using hourly code S9484 up to and including the fifth hour and per diem code S9485 for hours over the fifth up to and including the 24th.
07From the 25th hour forward, bill AIHP using the same codes.
08For mobile crisis services, use H2011 with the HT modifier.
09For IHS and 638 facilities billing labor and delivery, E/M codes may not be unbundled from the global OB code and billed separately, and those claims will be denied when billed in addition to the global code.
10confirm current applicability with AHCCCS before relying on these rules.
Codes mentioned
S9484S9485H2011
Original notice
AHCCCS DFSM Claims Clues - November 2018
azahcccs.gov · Always check the source before changing claims.
Related changes
See all Arizona Medicaid - AHCCCS changes →AHCCCS DFSM Claims Clues - October 2018MediumEffective Oct 1, 2018 · Claims & BillingAHCCCS DFSM Claims Clues - Updated Correction Notice - Updated Guidance on T1016 Code Allowance fora Provider with a Counseling Facility LicenseMediumEffective May 19, 2025 · Claims & BillingAHCCCS DFSM Claims Clues - May 2023 - Clarification of Billing Requirements for Behavioral Health Outpatient ClaimsHighEffective May 3, 2023 · Claims & BillingAHCCCS DFSM Claims Clues - May 2023 - Transaction Insight Portal for Outpatient Behavioral Health ProvidersMediumEffective May 9, 2023 · Claims & BillingBrowse every Arizona Medicaid - AHCCCS change in the policy list