MedicaidAdministrativeMedium impact
AHCCCS DFSM Claims Clues - April 2018
Arizona Medicaid - AHCCCS·AZ·Claims & Billing
Effective date
Apr 1, 2018
We identified it
Jun 17, 2026
Summary
AHCCCS has established a new provider type C5 for 638 FQHCs effective April 1, 2018, allowing Tribal 638 Clinics to elect FQHC status. The policy also clarifies All Inclusive Rate (AIR) billing rules, requiring UB-04 forms with limits of 5 AIRs per member per day, and updates paper claim submission requirements including mandatory ICD-10 codes.
Action Required
Immediately: Billing teams for Tribal 638 facilities must update provider registration to elect new C5 provider type for 638 FQHC status if desired. Update billing software to limit AIR claims to maximum 5 per member per day on separate UB-04 forms, with only 1 AIR per pharmacy visit. Ensure all paper claims use ICD-10 codes only and reject any DSM-4 codes for behavioral health services. Add modifiers JG and TB to specified drug codes for 340B program reporting.